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Original Research
Issues of Cardiovascular Risk Management in People With Diabetes in the COVID-19 Era
Antonio Ceriello, Eberhard Standl, Doina Catrinoiu, Baruch Itzhak, Nebojsa M. Lalic, Dario Rahelic, Oliver Schnell, Jan Škrha, Paul Valensi, on behalf of the Diabetes and Cardiovascular Disease (D&CVD) EASD Study Group
Diabetes Care 2020 May; dc200941. https://doi.org/10.2337/dc20-0941
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Abstract

People with diabetes compared with people without exhibit worse prognosis if affected by coronavirus disease 2019 (COVID-19) induced by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), particularly when compromising metabolic control and concomitant cardiovascular disorders are present. This Perspective seeks to explore newly occurring cardio-renal-pulmonary organ damage induced or aggravated by the disease process of COVID-19 and its implications for the cardiovascular risk management of people with diabetes, especially taking into account potential interactions with mechanisms of cellular intrusion of SARS-CoV-2. Severe infection with SARS-CoV-2 can precipitate myocardial infarction, myocarditis, heart failure, and arrhythmias as well as an acute respiratory distress syndrome and renal failure. They may evolve along with multiorgan failure directly due to SARS-CoV-2–infected endothelial cells and resulting endotheliitis. This complex pathology may bear challenges for the use of most diabetes medications in terms of emerging contraindications that need close monitoring of all people with diabetes diagnosed with SARS-CoV-2 infection. Whenever possible, continuous glucose monitoring should be implemented to ensure stable metabolic compensation. Patients in the intensive care unit requiring therapy for glycemic control should be handled solely by intravenous insulin using exact dosing with a perfusion device. Although not only ACE inhibitors and angiotensin 2 receptor blockers but also SGLT2 inhibitors, GLP-1 receptor agonists, pioglitazone, and probably insulin seem to increase the number of ACE2 receptors on the cells utilized by SARS-CoV-2 for penetration, no evidence presently exists that shows this might be harmful in terms of acquiring or worsening COVID-19. In conclusion, COVID-19 and related cardio-renal-pulmonary damage can profoundly affect cardiovascular risk management of people with diabetes.

Footnotes

  • ↵* A complete list of members of the Diabetes and Cardiovascular Disease (D&CVD) EASD Study Group can be found online at https://www.dcvd.org/.

  • This article is part of a special article collection available at https://care.diabetesjournals.org/collection/diabetes-and-COVID19.

  • Received April 25, 2020.
  • Accepted April 27, 2020.
  • © 2020 by the American Diabetes Association
https://www.diabetesjournals.org/content/license

Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. More information is available at https://www.diabetesjournals.org/content/license.

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Diabetes Care: 44 (3)

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Issues of Cardiovascular Risk Management in People With Diabetes in the COVID-19 Era
Antonio Ceriello, Eberhard Standl, Doina Catrinoiu, Baruch Itzhak, Nebojsa M. Lalic, Dario Rahelic, Oliver Schnell, Jan Škrha, Paul Valensi, on behalf of the Diabetes and Cardiovascular Disease (D&CVD) EASD Study Group
Diabetes Care May 2020, dc200941; DOI: 10.2337/dc20-0941

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Issues of Cardiovascular Risk Management in People With Diabetes in the COVID-19 Era
Antonio Ceriello, Eberhard Standl, Doina Catrinoiu, Baruch Itzhak, Nebojsa M. Lalic, Dario Rahelic, Oliver Schnell, Jan Škrha, Paul Valensi, on behalf of the Diabetes and Cardiovascular Disease (D&CVD) EASD Study Group
Diabetes Care May 2020, dc200941; DOI: 10.2337/dc20-0941
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