New guidelines to treat diabetes in COVID-19 patients

by Vicky Cerino, UNMC public relations | June 22, 2020

Image with caption: Andjela Drincic, M.D.

Andjela Drincic, M.D.

Hospitalized COVID-19 patients with diabetes represent more than 20 percent of the population of patients in intensive care units nationwide. Diabetes is a major risk factor for disease severity and mortality in patients with the COVID-19 virus and uncontrolled hyperglycemia -- high blood sugar -- is associated with longer stays in the hospital and higher death rates.

UNMC's Andjela Drincic, M.D., and colleagues from across the country recently published new, international guidelines for hyperglycemia treatment in the hospital setting. The guidelines could reduce the number of deaths and hospital stays in this population.

Co-authors included representatives from the University of Pittsburgh Medical Center, the University of Washington in Seattle, the Brigham and Women's Hospital and Harvard Medical School in Boston, the University of California in San Francisco, and the National Institutes of Health in Bethesda, Maryland.

The manuscript provides guidance for health care providers caring for patients hospitalized for COVID-19 who also have a prior history of diabetes or who have high blood sugar levels at the time of hospitalization. "A Pragmatic Approach to Inpatient Diabetes Management during the COVID-19 Pandemic" recently was published online in the Journal of Clinical Endocrinology & Metabolism, a leading peer-reviewed journal.

"Much has been written about the treatment of patients with COVID-19 in general, but little guidance has been provided to clinicians on how to treat their patients with diabetes," said Dr. Drincic, professor in the UNMC Department of Internal Medicine Division of Division of Diabetes, Endocrine and Metabolism. "And yet, hyperglycemia in this population is rampant and difficult to treat. We thought it was important to offer practicing physicians some guidance on how to address treatment of hyperglycemia, while minimizing exposure to health care workers and protect the use of personal protective equipment."

The paper includes modified protocols for insulin administration, recommendations on bedside glucose monitoring, the use of continuous glucose sensors, virtual glucose management and other aspects of models of care that can be provided by diabetes inpatient services.

She said hospitalized patients with COVID-19 and diabetes need to receive glucose-lowering therapy in addition to other complex medical management as a way of minimizing risk for complications and death. Clinicians also should be aware that some medications used in treating COVID-19 patients, including glucocorticoids and hydroxychloroquine, can affect blood glucose levels, she said.

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Dan Grice
June 22, 2020 at 4:03 PM

Thank you, Dr. Drincic, for speaking out and collaborating on these new guidelines for those who will benefit from such life-saving strategies. Kudos!