UP Philippine General Hospital Division of Endocrinology, Diabetes & Metabolism Consensus Recommendations for In-patient Management of Diabetes Mellitus among Persons with COVID-19
DOI:
https://doi.org/10.15605/jafes.035.01.05Keywords:
in-patient management, diabetes, COVID-19, SARS-COV-2Abstract
Diabetes mellitus (DM) is a known risk factor for morbidity and mortality among patients with COVID-19 based on recent studies. While there are many local and international guidelines on inpatient management of diabetes, the complicated pathology of the virus, the use of glucose-elevating drugs such as glucocorticoids, antivirals and even inotropes, and various other unique problems has made the management of in-hospital hyperglycemia among patients with COVID-19 much more difficult than in other infections. The objective of this guidance is to collate and integrate the best available evidence that has been published regarding in-patient management of diabetes among patients with COVID-19. A comprehensive review of literature was done and recommendations have been made through a consensus of expert endocrinologists from the University of the Philippines-Philippine General Hospital (UP-PGH) Division of Endocrinology, Diabetes and Metabolism. These recommendations are evolving as we continue to understand the pathology of the disease and how persons with diabetes are affected by this virus.
Downloads
References
Guan WJ, Ni ZY, Hu Y, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020;382(18):1708–20. https://www.ncbi.nlm.nih.gov/pubmed/32109013. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7092819. https://doi.org/10.1056/NEJMoa2002032.
Fadini GP, Morieri ML, Longato E, Avogaro A. Prevalence and impact of diabetes among people infected with SARS-CoV-2. J Endocrinol Invest. 2020. https://www.ncbi.nlm.nih.gov/pubmed/32222956. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7103097. https://doi.org/10.1007/s40618-020-01236-2.
Xu Y, Wang L, He J, et al. Prevalence and control of diabetes in Chinese adults. JAMA. 2013;310(9):948–59. https://www.ncbi.nlm.nih.gov/pubmed/24002281. https://doi.org/10.1001/jama.2013.168118.
Wang D, Hu B, Hu C, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA. 2020;323(11):1061–9. https://www.ncbi.nlm.nih.gov/pubmed/32031570. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7042881. https://doi.org/10.1001/jama.2020.1585.
Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China. JAMA. 2020;323(13):1239–42. https://www.ncbi.nlm.nih.gov/pubmed/32091533. https://doi.org/10.1001/jama.2020.2648.
Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: A retrospective cohort study. Lancet. 2020;395(10229):1054–62. https://www.ncbi.nlm.nih.gov/pubmed/32171076. https://doi.org/10.1016/S0140-6736(20)30566-3.
Remuzzi A, Remuzzi G. COVID-19 and Italy: What next? Lancet. 2020;395(10231):1225–8. https://www.ncbi.nlm.nih.gov/pubmed/32178769. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7102589.
https://doi.org/10.1016/S0140-6736(20)30627-9.
Bornstein SR, Rubino F, Khunti K, et al. Practical recommendations for the management of diabetes in patients with COVID-19. Lancet Diabetes Endocrinol [Internet]. 2020;8587(20):1–5. Available from: https://linkinghub.elsevier.com/retrieve/pii/S2213858720301522.
Bindom SM, Lazartigues E. The sweeter side of ACE2: Physiological evidence for a role in diabetes. Mol Cell Endocrinol.2009;302(2):193–202. https://www.ncbi.nlm.nih.gov/pubmed/18948167. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2676688. https://doi.org/10.1016/j.mce.2008.09.020.
Roca-Ho H, Riera M, Palau V, Pascual J, Soler MJ. Characterization of ACE and ACE2 expression within different organs of the NOD mouse. Int J Mol Sci. 2017;18(3). pii:E563. https://www.ncbi.nlm.nih.gov/pubmed/28273875.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5372579. https://doi.org/10.3390/ijms18030563.
Yang JK, Lin SS, Ji XJ, Guo LM. Binding of SARS coronavirus to its receptor damages islets and causes acute diabetes. Acta Diabetol. 2010;47(3):193–9. https://www.ncbi.nlm.nih.gov/pubmed/19333547. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7088164. https://doi.org/10.1007/s00592-009-0109-4.
Zhou J, Tan J. Diabetes patients with COVID-19 need better blood glucose management in Wuhan, China. Metab Clin Exp. 2020;107:154216. https://www.ncbi.nlm.nih.gov/pubmed/32220612. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7102634. https://doi.org/10.1016/j.metabol.2020.154216.
Sanders JM, Monogue ML, Jodlowski TZ, Cutrell JB. Pharmacologic treatments for coronavirus disease 2019 (COVID-19): A review. JAMA. 2020. https://www.ncbi.nlm.nih.gov/pubmed/32282022. https://doi.org/10.1001/jama.2020.6019.
Iqbal A, Prince LR, Novodvorsky P, et al. Effect of hypoglycemia on inflammatory responses and the response to low-dose endotoxemia in humans. J Clin Endocrinol Metab. 2019;104(4):1187–99. https://www.ncbi.nlm.nih.gov/pubmed/30252067. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6391720. https://doi.org/10.1210/jc.2018-01168.
Hussain A, Bhowmik B, do Vale Moreira NC. COVID-19 and diabetes: Knowledge in progress. Diabetes Res Clin Pract. 2020;162:108142. https://www.ncbi.nlm.nih.gov/pubmed/32278764. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7144611. https://doi.org/10.1016/j.diabres.2020.108142.
Diabetes UK. COncise adVice on Inpatient Diabetes (COVID: Diabetes): FRONT DOOR GUIDANCE. 2020. Available from: https://www.diabetes.org.uk/resources-s3/public/2020-04/COvID_Front_Door_v1.0.pdf.
Li J, Wang X, Chen J, Zuo X, Zhang H, Deng A. COVID-19 infection may cause ketosis and ketoacidosis. Diabetes Obes Metab. 2020. https://www.ncbi.nlm.nih.gov/pubmed/32314455. https://doi.org/10.1111/dom.14057.
Simonnet A, Chetboun M, Poissy J, et al. High prevalence of obesity in severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) requiring invasive mechanical ventilation. Obesity (Silver Spring).2020. https://www.ncbi.nlm.nih.gov/pubmed/32271993. https://doi.org/10.1002/oby.22831.
American Diabetes Association. 15. Diabetes Care in the Hospital: Standards of Medical Care in Diabetes-2020. Diabetes Care. 2020;43(Suppl 1):S193-202. https://www.ncbi.nlm.nih.gov/pubmed/31862758. https://doi.org/10.2337/dc20-S015.
Philippine Society of Endocrinology Diabetes and Metabolism. Position Statement on COVID-19 Infection and Diabetes. J ASEAN Fed Endocr Soc. 2020. https://doi.org/10.15605.jafes.035.01.02
International Diabetes Federation. COVID-19 outbreak: Guidance for people with diabetes. 2020. Available from: https://www.idf.org/our-network/regions-members/europe/europe-news/196-informationon-corona-virus-disease-2019-covid-19-outbreak-and-guidance-forpeople-with-diabetes.html.
NICE-SUGAR Study Investigators, Finfer S, Bellomo R, Blair D, et al. Intensive versus conventional glucose control in critically ill patients. N Engl J Med. 2009;360(13):1283–97. https://www.ncbi.nlm.nih.gov/pubmed/9318384. https://doi.org/10.1056/NEJMoa0810625.
Barazzoni R, Bischoff SC, Breda J, et al. ESPEN expert statements and practical guidance for nutritional management of individuals with SARS-CoV-2 infection. Clin Nutr. 2020. pii: S0261-5614(20)30140-0. https://www.ncbi.nlm.nih.gov/pubmed/32305181. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7138149. https://doi.org/10.1016/j.clnu.2020.03.022.
PhilSPEN. Guidance for Nutrition Therapy of Adults with Confirmed or Suspected COVID-19 [Internet]. Vol. 47;2020. Available from: https://philspen.org/philspen-covid-19-update-algorithms-formanaging-nutritional-issues-among-patients-with-covid-19/.
Pal R, Bhadada SK. Should anti-diabetic medications be reconsidered amid COVID-19 pandemic? Diabetes Res Clin Pract.2020;163(108146). https://www.ncbi.nlm.nih.gov/pubmed/32283128. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7151403. https://doi.org/10.1016/j.diabres.2020.108146.
Raj VS, Mou H, Smits SL, et al. Dipeptidyl peptidase 4 is a functional receptor for the emerging human coronavirus-EMC. Nature. 2013;495(7440):251–4. https://www.ncbi.nlm.nih.gov/pubmed/23486063. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7095326. https://doi.org/10.1038/nature12005.
Iacobellis G. COVID-19 and diabetes: Can DPP4 inhibition play a role? Diabetes Res Clin Pract. 2020;162:108125. https://www.ncbi.nlm.nih.gov/pubmed/32224164. https://doi.org/10.1016/j.diabres.2020.108125.
Umpierrez GE, Hellman R, Korytkowski MT, et al. Management of hyperglycemia in hospitalized patients in non-critical care setting: An endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2012;97(1):16–38. https://www.ncbi.nlm.nih.gov/pubmed/22223765. https://doi.org/10.1210/jc.2011-2098.
Chao WC, Tseng CH, Wu CL, Shih SJ, Yi CY, Chan MC. Higher glycemic variability within the first day of ICU admission is associated with increased 30-day mortality in ICU patients with sepsis. Ann Intensive Care. 2020;10(1):17. https://www.ncbi.nlm.nih.gov/pubmed/ 32034567. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7007493. https://doi.org/10.1186/s13613-020-0635-3.
American College of Cardiology. HFSA/ACC/AHA Statement Addresses Concerns Re: Using RAAS Antagonists in COVID-19. 2020. Available from: https://www.acc.org/latest-in-cardiology/
articles/2020/03/17/08/59/hfsa-acc-aha-statement-addressesconcerns-re-using-raas-antagonists-in-covid-19.
de Simone G. Position Statement of the ESC Council on Hypertension on ACE-inhibitors and angiotensin receptor blockers. European Society of Cardiology. 2020. Available from: https://www.escardio.org/Councils/Council-on-Hypertension-(CHT)/News/position-statementof-the-esc-council-on-hypertension-on-ace-inhibitors-and-ang.
Casado-Arroyo R. Aspirin and diabetes mellitus in primary prevention: The endless conundrum. Ann Transl Med. 2018;6(11):218. https://www.ncbi.nlm.nih.gov/pubmed/30023381. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6035968. https://doi.org/10.21037/atm.2018.03.26.
American Diabetes Association. 10. Cardiovascular Disease and Risk Management: Standards of Medical Care in Diabetes-2020. Diabetes Care. 2020;43(Suppl 1):S111-34. https://www.ncbi.nlm.nih.gov/pubmed/31862753. https://doi.org/10.2337/dc20-S010.
Josol C, Cardino M, Jimeno C, Isip-Tan I. Efficacy and safety of the UP-PGH endocrine insulin infusion protocol in controlling hyperglycemia in UP-PGH Medical Intensive Care Unit and Central Intensive Care Unit. Unpublished. 2009.
Ngalob Q, Jimeno C, Isip-Tan IT. Evaluation of effectiveness and safety of an ICU insulin infusion protocol. J ASEAN Fed Endocr Soc. 2014;29(1):33–41. https://doi.org/10.15605.jafes.29.02.05
Zhang W, Zhao Y, Zhang F, et al. The use of anti-inflammatory drugs in the treatment of people with severe coronavirus disease 2019 (COVID-19): The perspectives of clinical immunologists from China. Clin Immunol. 2020;214:108393. https://www.ncbi.nlm.nih.gov/pubmed/32222466.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7102614. https://doi.org/10.1016/j.clim.2020.108393.
World Health Organization. WHO Clinical management of severe acute respiratory infection (SARI) when COVID-19 disease is suspected [Internet]. World Health Organization. 2020. Available from: https://www.who.int/publications-detail/clinical-managementof-severe-acute-respiratory-infection-when-novel-coronavirus-(ncov)-infection-is-suspected.
Philippine Society of Allergy Asthma and Immunology. A review of immunomodulators as therapeutic interventions for moderate to severe COVID-19 infections [Internet]. Unpublished. 2020. Available from: https://pps.org.ph/wp-content/uploads/2020/04/LOGO-PSAAICOVID-19-Immunomodulator-Review-4-22-2020-DBA1.pdf.
Tamez-Pérez HE. Steroid hyperglycemia: Prevalence, early detection and therapeutic recommendations: A narrative review. World J Diabetes. 2015;6(8):1073–81. https://www.ncbi.nlm.nih.gov/pubmed/26240704. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4515447. https://doi.org/10.4239/wjd.v6.i8.1073.
Kitabchi AE, Umpierrez GE, Murphy MB, Kreisberg RA. Hyperglycemic crises in adult patients with diabetes: A consensus statement from the American Diabetes Association. Diabetes Care. 2006;32(7):1335–43. https://www.ncbi.nlm.nih.gov/pubmed/19564476. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2699725. https://doi.org/10.2337/dc09-9032.
Published
How to Cite
Issue
Section
License
Journal of the ASEAN Federation of Endocrine Societies is licensed under a Creative Commons Attribution-NonCommercial 4.0 International. (full license at this link: http://creativecommons.org/licenses/by-nc/3.0/legalcode).
To obtain permission to translate/reproduce or download articles or use images FOR COMMERCIAL REUSE/BUSINESS PURPOSES from the Journal of the ASEAN Federation of Endocrine Societies, kindly fill in the Permission Request for Use of Copyrighted Material and return as PDF file to jafes@asia.com or jafes.editor@gmail.com.
A written agreement shall be emailed to the requester should permission be granted.
