Department of Endocrinology and Nutrition, Cliniques Universitaires Saint-Luc, avenue Hippocrate 10, 1200 Brussels, Belgium; Department of Endocrinology, Diabetology and Nutrition, IREC, UCLouvain, avenue Hippocrate 55, Brussels, Belgium.
Department of Endocrinology and Nutrition, Cliniques Universitaires Saint-Luc, avenue Hippocrate 10, 1200 Brussels, Belgium.
Ann Endocrinol (Paris). 2020 Jun;81(2-3):101-109. doi: 10.1016/j.ando.2020.05.001. Epub 2020 May 12.
Diabetes is among the most frequently reported comorbidities in patients infected with COVID-19. According to current data, diabetic patients do not appear to be at increased risk of contracting SARS-CoV-2 compared to the general population. On the other hand, diabetes is a risk factor for developing severe and critical forms of COVID-19, the latter requiring admission to an intensive care unit and/or use of invasive mechanical ventilation, with high mortality rates. The characteristics of diabetic patients at risk for developing severe and critical forms of COVID-19, as well as the prognostic impact of diabetes on the course of COVID-19, are under current investigation. Obesity, the main risk factor for incident type 2 diabetes, is more common in patients with critical forms of COVID-19 requiring invasive mechanical ventilation. On the other hand, COVID-19 is usually associated with poor glycemic control and a higher risk of ketoacidosis in diabetic patients. There are currently no recommendations in favour of discontinuing antihypertensive medications that interact with the renin-angiotensin-aldosterone system. Metformin and SGLT2 inhibitors should be discontinued in patients with severe forms of COVID-19 owing to the risks of lactic acidosis and ketoacidosis. Finally, we advise for systematic screening for (pre)diabetes in patients with proven COVID-19 infection.
糖尿病是 COVID-19 感染患者中报告最多的合并症之一。根据目前的数据，与普通人群相比，糖尿病患者似乎没有更高的感染 SARS-CoV-2 的风险。另一方面，糖尿病是 COVID-19 发展为严重和危重症的危险因素，后者需要入住重症监护病房和/或使用有创机械通气，死亡率较高。目前正在研究易发生 COVID-19 严重和危重症的糖尿病患者的特征，以及糖尿病对 COVID-19 病程的预后影响。肥胖是 2 型糖尿病发病的主要危险因素，在需要有创机械通气的 COVID-19 危重症患者中更为常见。另一方面，COVID-19 通常与糖尿病患者血糖控制不佳和酮症酸中毒风险增加有关。目前没有建议停止与肾素-血管紧张素-醛固酮系统相互作用的降压药物。由于乳酸酸中毒和酮症酸中毒的风险，应在 COVID-19 严重患者中停止使用二甲双胍和 SGLT2 抑制剂。最后，我们建议对确诊 COVID-19 感染的患者进行（前）糖尿病的系统筛查。
