Review of Evidence for Altering Baseline Glycemic Control Medications for COVID-19 Prevention and Mitigation

Keeping on the evidence based theme…what about glycemic control medications? Should providers change them? (hint: no)

As evidence regarding the increased risk for poor outcomes in COVID infected patients suffering with diabetes has grown; interest in the impact of glycemic control medications in the disease process has grown with it. As we have seen with Renin-angiotensin-aldosterone system (RAAS) inhibitors, there are many theories regarding how altering a patient's baseline glycemic control medications may positively or negatively impact COVID outcomes. However, there is very little clinical evidence to back up any particular theory and most providers are all too familiar with promising treatments that don’t stand up in clinical reality.  

That being said, providers want to do whatever they can to help protect their patients from harm. And let’s face it, there is not a provider in the world who has the experience working in a pandemic like we are all experiencing together now. How do we wade through all the evidence to ensure that in our quest to keep our patients safe, we first remember ‘do no harm’?  

We are going to have to figure out a better system overall to selectively summarize articles and disperse information to the busy office based practitioners regarding chronic care issues and COVID as has been done with algorithms for inpatient care.  

Before a robust system for information delivery is put in place, here is a summary of what you need to know about glycemic control medications:

Overall: There is currently no evidence that supports changing currently effective glycemic control medication regimes for individual patients for prevention of COVID or COVID complications. The studies on individual medications are almost all retrospective at this point, and mostly show no harm or benefit with different diabetes medication classes. The best thing for providers to do at this point is to help their patients achieve good glycemic control with whatever medication regimen is necessary for each individual patient.