Table 3.

Benefits, risks and recommendations for anti-diabetic treatment with COVID-19 and diabetes mellitus.

Pharmacotherapy	Benefits	Risks	Recommendations
Insulin	Precise dosing possible for better glucose control. Better COVID-19 outcomes.	Increased risk of hypoglycemia (special care should be taken in combination with chloroquine therapy). High insulin requirements in critically ill patients.	Indicated in severe COVID-19.
Metformin	Anti-inflammatory activity.	Increased risk of lactic acidosis especially in critically ill patients.	Contraindicated in severe COVID-19.
SGLT-2 inhibitors (Sodium-glucose-co-transporter-2)	No hypoglycemic effect.	Increased risk of dehydratation and ketoacidiosis	Contraindicated in severe COVID-19.
Sulfonylureas	Not applicable	Increased risk of hypoglycemia (special care should be taken in combination with chloroquine therapy).	Not recommended in severe COVID-19 and increased risk of hypoglycemia.
GLP-1 receptor agonists (Glucagon-like peptide 1)	No hypoglycemic effect, anti-inflammatory activity	Increased risk of dehydratation	It is possible to continue the therapy provided an adequate fluid intake and regular meals are consumed
Thiazolidinediones	Insulin resistance reduction, anti-inflammatory activity	Increased risk of fluid retention.	Not recommended in severe COVID-19 and heart failure.
DPP-4 inhibitors (Dipeptidyl peptidase 4)	No hypoglycemic effect, good treatment tolerance	Not applicable	Continuation of treatment indicated