The management of cardiovascular risk in patients with diabetes admitted with coronavirus disease 2019 (COVID-19), which has been found to affect multiple organs, including the heart, kidneys, and lungs, should be adapted to this population, according to an article by an international team of diabetes and endocrinology experts published in Diabetes Care.
In patients with diabetes, a severe infection with SARS-CoV-2 can cause arrhythmias, myocardial infarction, myocarditis, and heart failure. Guidelines recommend that clinicians assess the extent of underlying cardiovascular conditions in patients with COVID-19, if present, in an effort to reduce the risks of subsequent cardiovascular episodes.
Several biomarkers may indicate a more severe outcome in patients with COVID-19 and concomitant metabolic disorders, such as diabetes. These biomarkers include high levels of C-reactive protein, hs-troponin, brain natriuretic peptide/N-terminal prohormone BNT, and D-dimer. Some of these biomarkers may be useful in risk prediction as well as in following the evolution of the disease in patients with diabetes.
In patients with diabetes, hypertension and COVID-19, appropriate control of blood pressure is essential. The severe acute respiratory syndrome coronavirus 2 that causes COVID-19 enters host cells by binding to angiotensin converting enzyme 2 (ACE 2) at the cell surface. ACE inhibitors and angiotensin receptor blockers have been shown to increase expression of ACE2 at the cell membrane, thus enhancing penetration of the virus. However, scientific organizations have not recommended discontinuing these drugs in patients taking them for hypertension, as evidence indicates that they are safe in patients with COVID-19.
Patients with hyperglycemia who present to the hospital with COVID-19 are at a greater risk for admission to the intensive care unit (ICU) and have a worse prognosis. Glycemic variability, which is common in patients with diabetes who are admitted to the ICU for COVID-19, also increases the risk for ICU mortality. Intravenous insulin is recommended during hospitalization to control blood sugar, and glucose should be monitored continuously to limit glycemic excursions.
“Considering that [cardiovascular disease] represent the leading epidemic in diabetes, it is mandatory to set long-term strategies not only aiming to avoid the infection but also to have people with diabetes in the best [cardiovascular] conditions if infected,” noted the study authors.
Ceriello A, Standl E, Catrinoiu D, et al. Issues of Cardiovascular Risk Management in People With Diabetes in the COVID-19 Era [published online May 14, 2020]. Diabetes Care. doi:10.2337/dc20-0941