Fig. 8

Diabetes treatment in patients with COVID-19. There is no reason to stop metformin therapy during COVID-19 infection unless there are severe gastrointestinal symptoms, or risk of lactic acidosis. Metformin can be a beneficial adjuvant therapy for patients in acute, chronic, and even recovery phases of COVID-19. The continued use of sulfonylurea in stable patients with COVID-19 who are eating regular meals may be justified. However, we need to be alert to any potential risks of hypoglycemia, especially in patients with COVID-19 in intensive care units. A theoretical anti-viral effect of SGLT2-inhibitors was suggested, however caution should be taken when using these drugs because they require hydration and appropriateness of insulin doses to prevent euglycemic ketoacidosis. GLP-1 receptor agonists should be carefully evaluated in severely ill patients with COVID-19 considering their anorexic effects. However, their potential beneficial effects should also be balanced, because these drugs have anti-inflammatory and lung protection actions and can be valuable weapons to combat COVID-19. DPP-4 inhibitors are a group of drugs associated with many advantages, even in severe cases of COVID-19, because they are well tolerated, can be used independent of renal function, and have a low risk of hypoglycemia. In this regard, we should consider recommending a more widespread use of DPP4 inhibitors in diabetic inpatients with severe COVID-19. In most studies, DM2 patients with COVID-19 on insulin have shown a worse prognostic, usually attributed to the severity of diabetes in these patients. However, by lowering the doses of insulin, by association with oral anti-hyperglycemic agents, it is possible to attenuate this potential worse effect of high doses of insulin