Medicus, Vol. 29 No. 2 COVID-19, 2020.
Review article
COVID-19 and Pharmacological Treatment of Type 2 Diabetes
Tomislav Bulum
Abstract
Patients with type 2 diabetes (DM2) are at increased risk of viral infections and related respiratory complications. COVID-19 (Coronavirus Disease-2019) is a viral infection caused by coronavirus 2 (SARS-CoV-2), that has led to a pandemic affecting more than 100 countries across the globe. Studies to date have reported that patients with DM2 are at a significantly higher mortality risk from COVID-19. Accordingly, it is important to understand shared pathophysiology pathways between effects of pharmacological drugs and COVID-19 infection in order to choose the optimal treatment of DM2. Angiotensin-converting enzyme 2 (ACE2) and dipeptidyl peptidase-4 (DPP-4) are coronavirus receptors that are also involved in glucose control, renal and cardiovascular physiology, and metabolic pathways including inflammation processes. Metformin, the gold standard treatment for DM2, should be avoided in patients with severe COVID-19 because of risk of dehydration and lactic acidosis. Sodiumglucose co-transporter-2 (SGLT2) inhibitors should also be avoided in patients with severe COVID-19 because of risk of dehydration and euglycemic diabetic ketoacidosis, and because they also promote renal ACE2 activity. Sulfonylureas are safe in patients with COVID-19, although there is a higher risk of hypoglycemia. Due to their immunomodulatory effect, DPP-4 inhibitors may prevent and reduce the risk and progression of acute respiratory complications (cytokine storm) in patients with DM2. Glucagon-like peptide-1 receptor (GLP-1) agonists should be used with caution, along with adequate intake of food and liquids because of higher risk of dehydration, and also because GLP-1 agonists upregulate ACE2 in animal models. Although insulin increases intrarenal ACE2 expression in animal models, insulin therapy should be prescribed in all hospitalized patients with severe or critical disease. However, regular monitoring of blood-glucose is needed. DM2 should continue with their antihypertensive regimens including renin–angiotensin–aldosterone system (RAAS) inhibitors.
Keywords
type 2 diabetes; COVID-19; pharmacological treatment
Hrčak ID:
244332
URI
Publication date:
30.9.2020.
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