• Cecilia Jimeno University of the Philippines-Philippine General Hospital
  • Ma. Cecille Anonuevo-Cruz University of the Philippines-Philippine General Hospital
  • Angelique Bea Uy University of the Philippines-Philippine General Hospital
  • Adrian Oscar Bacena University of the Philippines-Philippine General Hospital
  • Mark David Francisco University of the Philippines-Philippine General Hospital
  • Angelique Love Tiglao-Gica University of the Philippines-Philippine General Hospital
  • Racquel Bruno University of the Philippines-Philippine General Hospital
  • Diane Grace Corpuz University of the Philippines-Philippine General Hospital
Keywords: in-patient management, diabetes, COVID-19, SARS-COV-2


This consensus guidelines  collates and integrates 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 UP-PGH Division of Endocrinology, Diabetes and Metabolism.


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Author Biographies

Cecilia Jimeno, University of the Philippines-Philippine General Hospital

Division of Endocrinology, Diabetes and Metabolism

Ma. Cecille Anonuevo-Cruz, University of the Philippines-Philippine General Hospital

Division of Endocrinology, Diabetes and Metabolism

Angelique Bea Uy, University of the Philippines-Philippine General Hospital

Division of Endocrinology, Diabetes and Metabolism

Adrian Oscar Bacena, University of the Philippines-Philippine General Hospital

Division of Endocrinology, Diabetes and Metabolism

Mark David Francisco, University of the Philippines-Philippine General Hospital

Division of Endocrinology, Diabetes and Metabolism

Angelique Love Tiglao-Gica, University of the Philippines-Philippine General Hospital

Division of Endocrinology, Diabetes and Metabolism

Racquel Bruno, University of the Philippines-Philippine General Hospital

Division of Endocrinology, Diabetes and Metabolism

Diane Grace Corpuz, University of the Philippines-Philippine General Hospital

Division of Endocrinology, Diabetes and Metabolism


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.


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.


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.


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.


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/ 19318384. 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. PMID: 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/


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.

How to Cite
Jimeno, C., Anonuevo-Cruz, M. C., Uy, A. B., Bacena, A. O., Francisco, M. D., Tiglao-Gica, A. L., Bruno, R., & Corpuz, D. G. (2020). UP Philippine General Hospital Division of Endocrinology, Diabetes & Metabolism CONSENSUS RECOMMENDATIONS FOR IN-PATIENT MANAGEMENT OF DIABETES MELLITUS AMONG PERSONS WITH COVID-19 . Journal of the ASEAN Federation of Endocrine Societies, 35(1). Retrieved from https://asean-endocrinejournal.org/index.php/JAFES/article/view/821
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