Table 1.

Proposed clinical guidance for the use of SGLT2i in patients with COVID‐19

	Mild COVID‐19	Moderate COVID‐19
Previously taking SGLT2 inhibitors
Newly initiated SGLT2 inhibitors
Long duration of disease with severe COVID‐19	Insulin alone or Insulin (multiple subcutaneous insulin or continuous intravenous infusion) with SGLT2i

In patients with mild to moderate COVID‐19 without significant organ injury, continuation of SGLT2i seems to be prudent to possibly reduce severity of infection by favourably regulating multiple cardiovascular risk factors. In patients with mild to moderate COVID‐19, initiating SGLT2i needs to be a case‐based approach balancing the benefits in new‐onset hyperglycaemia, heart failure, myocarditis, arrhythmias, cytokine storm induced myocarditis and acute tubular necrosis versus risks of euglycaemic diabetic ketoacidosis. In patients with long‐standing diabetes (poor β‐cell reserve) especially with severe COVID‐19, insulin remains the choice of therapy. Adjunctive usage of SGLT2i may be beneficial in certain patients with close clinical surveillance for ketoacidosis.