Australian clinicians provide tips for managing diabetes in COVID-19

People with diabetes appear to be at increased risk of severe COVID-19 disease and as a group may have the most to gain from the move to telehealth.

Their use of diabetes technology such as CGM and flash glucose monitoring with automatic uploads means telehealth appointments can be well informed but challenges remain.

In an article to the MJA, a team from the University of Sydney including senior author Professor Gregory Fulcher, outlined some of the considerations in managing patients with diabetes during the pandemic.

They said evidence from the previous SARS coronavirus epidemic showed the association between diabetes and mortality was driven by glycaemic control.

“This further highlights the need to maintain ongoing medical care to optimise glucose control throughout the current COVID-19 pandemic.”

They said it was prudent for patients with diabetes to try to quit smoking.

“In addition, having the recently available influenza vaccine, which is usually recommended for people with diabetes, would be advisable, although patients should be aware that this will not protect against COVID19.”

They reinforced the importance of patients having clear action plans for managing their diabetes if they became unwell.

For example, individuals using hybrid closed loop insulin pumps such as Medtronic 670G should be taught to exit the auto mode and instead opt for manual correction boluses of insulin and a temporary increased basal rate.

“The algorithm within the hybrid closed pump may otherwise not adapt quickly enough to manage hyperglycaemia during acute illness.”

They also said patients should be aware of guidance to withhold SGLT2 inhibitors during illness to minimise the risk of ketoacidosis.

“This should be reiterated to general practitioners and emergency physicians to screen for SGLT2 use in those presenting with COVID-19 or any illness.”

Despite interest in a link between ACE inhibitors and ARBs and upregulation ACE2 with COVID-19, patients should not be switched until there was more information.

“Currently, there is little evidence to suggest changing antihypertensive therapy and multiple national and international bodies including the Australian Diabetes Society, American College of Cardiology and European Society of Hypertension have
recommended that ACE inhibitors and ARBs should not be ceased.”

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