COVID-19 and Diabetes Mellitus Management

Öz

SARS-CoV-2 infection has a more severe course in diabetic patients, intensive care needs and mortality related to the disease are more common in these patients. Angiotensin converting enzyme-2 (ACE2) is the main receptor of SARS-CoV-2. Increased ACE2 expression in the lungs of diabetic patients and glycolysis of these receptors with hyperglycemia make them more susceptible to COVID-19. In addition, acute or chronic hyperglycemia contributes to the severity of COVID-19 infection in patients with diabetes by impairing innate and acquired immune function. It is also thought that SARS-CoV-2 may cause the development of new diabetes cases and lead to an increase in the frequency of type 1 diabetes. Providing glycemic control is important in improving the prognosis of COVID-19 in diabetic patients. It provides significant reductions in mortality rates by providing glycemic regulation. Insulin therapy should be preferred in severe patients with respiratory distress and in critical COVID-19 cases. If glycemic control is achieved in mildly symptomatic or asymptomatic individuals, current treatment is continued. There is no need to discontinue oral antidiabetic therapies in these patients. If glycemic control cannot be achieved, their treatments are intensified according to the current diabetes treatment guidelines. Antidiabetic treatment revision should be made considering that dexamethasone and remdesivir treatments used in the treatment of COVID-19 may impair glycemic control. Blood glucose targets should be between 140-180 mg/dl in diabetic COVID-19 cases, and the lower limit can be reduced to 110 mg/dl in those who do not have hypoglycemia risk.

Anahtar Kelimeler

• Antidiabetic drugs
• COVID-19
• Diabetes

COVID-19 ve Diabetes Mellitus Yönetimi

Öz

Diyabetik hastalarda SARS-CoV-2 enfeksiyonu daha şiddetli seyretmekte, hastalığa bağlı yoğun bakım ihtiyaçları ve mortalite daha sık görülmektedir. Anjiyotensin dönüştürücü enzim-2 (ACE2), SARS-CoV-2'nin ana reseptörüdür. Diyabetli hastaların akciğerlerinde ACE2 ifadesinin artması ve hiperglisemi ile bu reseptörlerin glikozillenmesi onları COVID-19'a daha duyarlı hale getirir. Bununla birlikte akut veya kronik hiperglisemi doğal ve edinsel bağışıklık fonksiyonunu bozarak diyabetli hastalarda COVID-19 enfeksiyonunun ciddiyetine katkıda bulunur. SARS-CoV-2 yeni diyabet olguların gelişmesine neden olabileceği ve tip 1 diyabet sıklığında artışa yol açacağı da düşünülmektedir. Diyabetik hastalarda COVID-19 prognozunu iyileştirmede glisemik kontrolün sağlanması önemlidir. Glisemik regülasyonun sağlanması ile mortalite oranlarında önemli azalmalar sağlamaktadır. Solunum sıkıntısı olan ciddi hastalar ve kritik COVID-19 olgularında insülin tedavisi tercih edilmelidir. Hafif semptomatik veya asemptomatik bireylerde glisemik kontrol sağlanmışsa mevcut tedavisine devam edilir. Bu hastalarda oral antidiyabetik tedavilerin kesilmesine gerek yoktur. Glisemik kontrol sağlanamamışsa güncel diyabet tedavi klavuzlarına göre tedavileri yoğunlaştırılır. COVID-19 tedavisinde kullanılan deksametazon ve remdesivir tedavilerinin glisemik kontrolü bozabileceği öngörülerek antidiyabetik tedavi revizyonu yapılmalıdır. Diyabetli COVID-19 olgularında kan şekeri hedeflerini 140-180 mg/dl arasında tutmalı, hipoglisemi riski olmayanlarda alt sınır 110 mg/dl’ye düşürülebilir.

Anahtar Kelimeler

• Antidiyabetik ilaçlar
• COVID-19
• Diyabet

Kaynakça

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