Table 3.
Antidiabetic treatment during COVID-19
| Advantages | Disadvantages | Interactions with COVID-19 treatments | |
|---|---|---|---|
| Metformin | No risk of hypoglycaemia | Risk of lactic acidosis in case of respiratory distress. Renal impairment. Heart failure |
Lopinavir |
| DPP-4 inhibitors | No risk of hypoglycaemia. Available for a wide renal function range. Potential anti-inflammatory action. Potential modification of SARS-CoV-2 binding to DPP-4 |
N/A | Lopinavir/ritonavir; Atazanavir |
| SGLT2-inhibitors | No risk of hypoglycaemia | Risk of hypovolemia. Electrolyte imbalances. Euglycaemic ketoacidosis |
Lopinavir/ritonavir |
| GLP-1 receptor agonists | No risk of hypoglycaemia. Potential anti-inflammatory action | Risk of gastrointestinal side-effects and aspiration | Atazanavir |
| Sulfonylureas | N/A | Risk of hypoglycaemia if oral intake is administered with other glucose-lowering agents | Lopinavir/ritonavir; Hydroxychloroquine |
| Pioglitazone | Anti-inflammatory action | Risk of fluid retention and heart failure | Favipiravir |
| Insulin | Recommended in critical patients | Risk of hypoglycaemia. Possible need for high doses. Intravenous administration |
Hydroxychloroquine |
Usual at home antidiabetic therapy can be maintained in patients receiving treatment in hospital with regular caloric and fluid intake according to the clinical status, risk of drug-related adverse effects, and interactions between antidiabetic agents and drugs used for the treatment of COVID-19. However, insulin is the preferred agent for glycaemic control in patients with diabetes receiving treatment in hospital, and its use is mandatory in critically ill patients. N/A=not applicable.