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. 2020 Aug 10;14(5):1579–1581. doi: 10.1016/j.dsx.2020.08.003

Table 1.

Hyperglycemia scenarios during COVID19, mortality and principles of management.

Hyperglycemia scenarios Situation in India Mortalitya Place of Care Management/solutions Means/Healthcare provider
1. Pre-existing poor glycemic control without covid19, or mild covid19 Uncontrolled glycemia in about 60–70% patients High when infected with COVID19 Home, outpatients
  • -

    Reconnect with patients,

  • -

    emphasize importance of good glycemic control;

  • -

    Empower change in therapy in simple manner

 Tele consultation
2. Hyperglycemia at admission (both patients with and without diabetes) with COVID19
  • -

    Likely possibility in known patients with diabetes

  • -

    Also, in individuals not known to be having diabetesa

High Hospital (in-patients)
  • -

    HbA1c to rule out previous diabetes.

  • -

    Escalate therapy if required as soon as COVID-19 is diagnosed.

  • -

    Escalate metformin if no abdominal distress or other contraindications.

 In-hospital diabetes expert and/or COVID19 care teamb
3. Hyperglycemia in pregnancy with COVID19 a a Home, hospital (in-patients)
  • -

    Use capillary blood glucose for screening (oral glucose tolerance test avoided)a

  • -

    SMBG and CGMS for monitoring
  • -

    Teleconsultation.

  • -

    In-hospital managementb if needed
4. Hyperglycemia during hospital stay with COVID19 Not well researched but likely High Hospital (in-patients), intensive care unit Aggressive management with insulin In-hospital diabetes expert and/or COVID19 care teamb
5. New-onset diabetes a High
  • -

    Hospital (in-patients), Intensive care (if ketoacidosis or marked hyperglycemia)

  • -

    Outpatients/home
  • -

    Insulin (for marked hyperglycemia and ketoacidosis)

  • -

    Oral drugsa

  • -

    In-hospital diabetes expert and/or COVID19 care teamb

  • -

    Teleconsultation in case of outpatients care

SMBG, Self-monitoring of blood glucose; CGMS, Continuous glucose monitoring system.

a

Not well researched in India.

b

In absence of diabetes expert, simplified management regimen (insulin initiation and continuation algorithm and fluid and electrolyte treatment) should be followed by COVID19 care team. Teleconsultation between COVID19 care team/critical care team and diabetes expert should be encouraged.