Table 1.
Use of antidiabetic medications in patients with type 2 diabetes and coronavirus disease 2019
|
Insulin
|
Sulfonylurea
|
Metformin
|
DPP-4 inhibitors
|
SGLT-2is
|
GLP-1a
|
Benefits | Guarantee of achieving glycemic control; Cardiovascular neutrality; Possible use in multivisceral failure | Cardiovascular neutrality (demonstrated only with Glimepiride) | Probable cardiovascular benefit; No risk of hypoglycemia improvement of inflammation and endothelial dysfunction | Cardiovascular neutrality; Possible use in severe renal impairment and hypoxia; Possible inhibitory role on the entry of the virus into the cell; No risk of hypoglycemia | Proved cardiovascular and renal protective benefits; No risk of hypoglycemia Improvement of inflammation | Proved cardiovascular and renal protective benefits; Possibility of use up to the stage of severe renal failure; No risk of hypoglycemia; Improvement of inflammation and endothelial dysfunction |
Risks | Increased glycaemic variability hypoglycaemic risks | Hypoglycaemic risk, contraindication in case of severe liver and renal failure | Multiple contraindications (hypoxia, severe renal failure, severe heart failure, severe liver failure); Risk of lactic acidosis especially in severe renal failure | Possible dysregulation of T cell function and T cell mediated inflammatory and immune responses | Reduced efficacy in moderate to severe renal impairment; Risk of ketoacidosis, especially in severe sepsis Risk of dehydration | Risk of digestive side effects; Risk of worsening undernutrition |
Association with severe form of COVID-19 in observational studies | Conflicting results | Lower risk of severe form of COVID-19 or neutral association | Lower risk of severe form of COVID-19 or neutral association | Conflicting results | Lower risk of severe form of COVID-19 or neutral association | Neutral association |
Medication use and severity of COVID-19 infection | Possibility of use at all stages of the disease and particularly in severe forms, especially recommended if blood sugar level is over 10-11 mM | Possible use up to moderate forms in the absence of severe renal and liver failure | Recommended use up to moderate forms in the absence of contraindications | Possible use up to moderate forms | Possible use up to moderate forms in the absence of moderate to severe renal failure | Possible use up to moderate forms |
COVID-19: Coronavirus disease 2019; DPP-4: Dipepetidyl peptidase-4; SGLT-2is: Sodium-glucose cotransporter-2 inhibitors; GLP-1a: Glucagon like peptide-1 analogues.