Proposed algorithm guides in-hospital CV risk management in COVID-19 with diabetes

  • Ceriello A & al.
  • Diabetes Care
  • 14 May 2020

  • curated by Miriam Tucker
  • Clinical Essentials
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Takeaway

  • Worse COVID-19 outcomes with diabetes likely relate to cardiovascular (CV) comorbidities.
  • COVID-19-related cardio-renal-pulmonary damage affects CV risk management for people with diabetes.

Study design

  • Expert opinion of Diabetes and Cardiovascular Disease Study Group of the European Association for the Study of Diabetes.
  • Funding: None disclosed.

Suggested strategies

  • On admission, evaluate for >1 risk factors:
    • Hypertension, diabetes, obesity, smoking.
  • If yes, assess for:
    • Lung disease, coronary artery disease, myocardial infarction, heart failure, arrhythmias, transient ischemic attack/stroke, peripheral arterial disease, chronic kidney disease.
  • Assess biomarkers:
    • High C-reactive protein, elevated creatinine/estimated glomerular filtration rate /minute/1.73 m2, HbA1c >7.5% (58 mmol/mol), hyperglycemia, abnormal blood gas, elevated hs-troponin, high natriuretic peptide, elevated D-dimer, ferritin, increased creatinine kinase.
  • In intensive care:
    • Stop oral glucose-lowering agents and subcutaneous insulin.
    • Switch to intravenous insulin for glucose control (perfusor).
    • Use continuous glucose monitoring (CGM) if available.
    • Abstain from steroids.
    • Continue renin-angiotensin system (RAS) inhibitors and statins.
    • Use appropriate anticoagulation.
  • On the general ward:
    • Consider contraindications to metformin, sulfonylureas, sodium-glucose transporter 2 inhibitors, pioglitazone, a-glucosidase inhibitors.
    • Preferentially consider dipeptidyl peptidase-4 inhibitors, glucagon-like peptide-1 receptor agonists, subcutaneous insulin for glucose control.
    • Use CGM if available.
    • Consider glycemic effects of experimental anti-COVID-19 drugs (e.g., hydroxychloroquine).
    • Abstain from steroids.
    • Continue RAS inhibitors/statins, appropriate anticoagulation.