Pharmacotherapeutic considerations for the management of diabetes mellitus among hospitalized COVID-19 patients.

Hasan, Syed Shahzad; Kow, Chia Siang; Bain, Amie; Kavanagh, Sallianne; Merchant, Hamid A; Hadi, Muhammad Abdul

INTRODUCTION Diabetes mellitus is one of the most prevalent comorbidities identified in patients with coronavirus disease 2019 (COVID-19). Since diabetes is a significant risk factor associated with poor prognosis among COVID-19 patients, this article aims to discuss the pharmacotherapeutic considerations for the management of diabetes in hospitalized patients with COVID-19. AREAS COVERED This paper presents a critical and comprehensive review of existing literature to present various aspects of diabetes management in hospitalized patients with COVID-19 and is divided into three sections (i) susceptibility and severity of COVID-19 among individuals with diabetes, (ii) glycaemic goals for hospitalized COVID-19 patients with diabetes, (iii) pharmacological treatment considerations for diabetes in hospitalized COVID-19 patients. EXPERT OPINION The inpatient goal of therapy in both COVID-19 patients with type 1 (T1DM) and type 2 diabetes (T2DM) is to avoid disruption of stable metabolic state, tight glycaemic control, and prevent adverse glycaemic events. Patients with T1DM require insulin therapy at all times to prevent ketosis. The management strategy for T2DM includes temporary discontinuation of certain oral antidiabetic agents and consideration for insulin therapy, at least during hospitalization. Patients with T2DM who are relatively stable and able to eat regularly may continue with oral hypoglycaemic agents if glycaemic control is satisfactory. Hyperglycaemia should be anticipated in patients with systemic corticosteroid treatment and managed upon accordingly.