Features of management of patients with endocrineand metabolic disorders during the COVID-19pandemic: the statement from European Societyof Endocrinology

Abstract

The COVID-19 pandemic requires that doctors of all specialties, including endocrinologists, join forces in the fight against the SARS-CoV-2 virus. Only such an approach will preserve the health of the population and prevent the adverse effects associated with COVID-19 in people suffering from various chronic, including endocrine, diseases. Recent evidence suggests that not only patients with diabetes mellitus (DM), but also patients with other endocrine and metabolic disorders, such as obesity, malnutrition, as well as adrenal insufficiency, fall into the high-risk and unfavorable course of COVID-19. This review presents the guidelines for the management of patients with endocrine disorders and COVID-19, developed by the working group of the European Society of Endocrinology, for use by the entire endocrine community in this critical situation. It is emphasized that older people and patients with serious chronic diseases such as heart disease, lung disease, and DM have the highest risk of complications associated with COVID-19 infection. Chronic hyper­glycemia adversely affects the immune system, in­­creasing the risk of morbidity and mortality due to any infection, including COVID-19. In diabetic patients infected with SARS-CoV-2, glycemic control during the acute period is usually substantially impaired. Therefore, contacting a doctor by phone, e-mail or video link in case of possible symptoms of COVID-19 infection is strictly required to receive appropriate assistance. When considering the relationship between diabe­tes mellitus, hypoglycemic therapy, and COVID-19, importance is given to a molecule that acts as a receptor for SARS-CoV-2, namely, angiotensin-con­verting enzyme-2 (ACE2). Recently, it has been suggested that selective inhibitors of the sodium-dependent type 2 glucose cotransporter (SGLT-2), glucagon-like peptide-1 receptor agonists (GLP-1), pioglitazone and even insulin can induce overexpression of ACE2 receptors, which may have important negative consequences for people with DM with SARS-CoV-2 infection. This problem is of great importance, because in DM during the COVID-19 pandemic, optimal glycemic control is necessary and many patients are forced to take these sugar-lowering drugs. The experience of managing patients with severe obesity indicates that even in young adults COVID-19 often progresses towards destructive alveolitis with the development of respiratory failure and death, which can be promoted by developing sleep apnea syndrome, surfactant dysfunction, as well as significantly impaired glycemic control. As for patients with nutrition impairment, COVID-19 infection is associated with a high risk of developing malnutrition, mainly associated with increased nutritional requirements and the presence of severe acute inflammatory status. Although there is currently no objective reliable data on the outcome of COVID-19 infection in patients with adrenal insufficiency, such patients may be at a higher risk of medical complications and, ultimately, an increased risk of death in case of COVID-19 infection. In case of suspected COVID-19, a patient with adrenal insufficiency should immediately modify replacement therapy, namely, at least double the usual dose of glucocorticoid replacement to avoid an adrenal crisis.