COVID-19 and related cardio-renal-pulmonary damage can profoundly affect the cardiovascular risk management of people with diabetes. It is recommended to continue ACE inhibitors and angiotensin receptor blockers, both SGLT2 inhibitors and GLP-1 receptor agonists have anti-inflammatory activities, which might be beneficial for patients with COVID-19. However, several expert groups in diabetes have previously advised that SGLT2 inhibitors and metformin be stopped in all patients hospitalized with COVID-19. For patients not in the ICU, use DPP-4 inhibitors, GLP-1 agonists or subcutaneous insulin as preferred glucose-lowering options over the other medications. For patients in the ICU, stop all oral glucose-lowering agents and subcutaneous insulin and switch to IV insulin for glucose control, using exact dosing with a perfusion device aiming at a blood glucose target of 140-180 mg/dL (7.8-10.0 mmol/L).
