Manejo ambulatorio del paciente con diabetes en tiempos de COVID-19

El tratamiento ambulatorio de pacientes con enfermedades crónicas no transmisibles (ECNT) ofrece retos interesantes en el contexto de la pandemia por SARS-CoV-2 (COVID-19), que exigen un análisis individual de la diabetes. Es a lugar discutir elementos del tratamiento ambulatorio: desde implementación de modelos específicos, recomendaciones de cambios en el estilo de vida, orientación en comorbilidades, identificación de factores de riesgo adicionales, hasta sugerencias en cada uno de los grupos farmacológicos que acá competen. Todo lo anterior con el propósito de brindar el mejor soporte a los pacientes en el panorama no hospitalario.

1.Bornstein SR, Rubino F, Khunti K, Mingrone G, Hopkins D, Birkenfeld A, et al. Practical recommendations for the management of diabetes inpatients with COVID-19. Lancet Diabetes Endocrinol. 2020;8(6):546-50. doi: 10.1016/S2213-8587(20)30152-2.
2. Singh AK, Gupta R, Ghosh A, Misra A. Diabetes in COVID-19: Prevalence, pathophysiology, prognosis and practical considerations. Diabetes Metab Syndr. 2020;14(4):303-10. doi: 10.1016/j.dsx.2020.04.004.
3. Drucker DJ. Coronavirus Infections and Type 2 Diabetes-Shared Pathways With Therapeutic Implications. Endocr Rev. 2020;41(3):bnaa011. doi:10.1210/endrev/bnaa011.
4. Gupta R, Ghosh A, Singh ak, Misra a. Clinical considerations for patients with diabetes in times of COVID-19 epidemic. Diabetes Metab Syndr. 2020;14(3):211-2. doi:10.1016/j.dsx.2020.03.002.
5. de Simone G. Position statement of the ESC Council on Hypertension on ACE-inhibitors and angiotensin receptor blockers [Internet]. [Consultado 15 de abril de 2020]. Disponible en: https://bit.ly/36IKUHl.
6. Raj VS, Mou H, Smits SL, Dekkers DHW, Müller MA, Dijkman R, et al. Dipeptidyl peptidase 4 is a functional receptor for the emerging human coronavirus-EMC. Nature. 2013;495(7440):251-4. doi: 10.1038/nature12005.
7. Andersen CJ, Murphy KE, Fernandez ML. Impact of obesity and metabolic syndrome on immunity. Adv Nutr. 2016;7(1):66-75. doi: 10.3945/ an.115.010207.
8. International Diabetes Federation Europe. How to manage diabetes during an illness? “Sick Day Rules” [Internet]. Disponible en: https://bit. ly/3cg3urt.
9. Cameron AR, Morrison VL, Levin D, Mohan M, Forteath C, Beall C, et al. Anti-Inflammatory effects of metformin irrespective of diabetes status. Circ Res. 2016;119(5):652-65. doi: 10.1161/CIRCRESAHA.116.308445.
10. Iacobellis G. COVID-19 and diabetes: Can DPP4 inhibition play a role? Diabetes Research Clin Pract. 2020;162:108125. doi: 10.1016/j.diabres.2020.108125.
11. Mulvihill EE, Drucker DJ. Pharmacology, physiology, and mechanisms of action of dipeptidyl peptidase-4 inhibitors. Endocr Rev. 2014;35(6):992- 1019. doi:10.1210/er.2014-1035.
12. Zhou F, Zhang Y, Chen J, Hu X, Xu Y. Liraglutide attenuates lipopolysaccharide induced acute lung injury in mice. Eur J Pharmacol. 2016;791:735-40. doi:10.1016/j.ejphar.2016.10.016.
13. Drucker DJ. Mechanisms of action and therapeutic application of glucagon-like peptide-1. Cell Metab. 2018;27(4):740-56. doi: 10.1016/j. cmet.2018.03.001.
14. Marso SP, Daniels GH, Brown-Frandsen K, Kristensen P, Mann J, Nauck MA, et al. Liraglutide and cardiovascular outcomes in type 2 diabetes. N Engl J Med. 2016;375(4):311-22. doi: 10.1056/NEJMoa1603827.
15. Marso SP, Bain SC, Consoli A, Eliaschewitz FG, Jódar E, Leiter LA, et al. Semaglutide and cardiovascular outcomes in patients with type 2 diabetes. N Engl J Med. 2016;375(19):1834-44. doi: 10.1056/NEJMoa1607141.
16. Holman RR, Bethel MA, Mentz RJ, Thompson VP, Lokhnygina Y, Buse JB, et al. Effects of once weekly exenatide on cardiovascular outcomes in type 2 diabetes. N Engl J Med. 2017;377(13):1228-39. doi: 10.1056/NEJMoa1612917.
17. Gerstein HC, Colhoun HM, Dagenais GR, Diaz R, Lakshmanan M, Pais P, et al. Dulaglutide and cardiovascular outcomes in type 2 diabetes (REWIND): a double-blind, randomised placebo-controlled trial. Lancet. 2019;394(10193):121-30. doi: 10.1016/S0140-6736(19)31149-3.
18. American Diabetes Association. 9. Pharmacologic Approaches to Glycemic Treatment: Standards of Medical Care in Diabetes-2020. Diabetes Care. 2020;43(Suppl 1):S98-S110. doi: 10.2337/dc20-S009.
19. Hamblin PS, Wong R, Ekinci EI, Fourlanos S, Shah S, Jones A, et al. SGLT2 inhibitors increase the risk of diabetic ketoacidosis developing in the community and during hospital admission. J Clin Endocrinol Metab. 2019;104(8):3077-87. doi: 10.1210/jc.2019-00139.
20. Royal United Hospitals Bath. NHS Foundation Trust. Urgent Safety Notice: Use of SGLT-2 inhibitor during the COVID-19 crisis [Internet]. Disponible en: https://www.ruh.nhs.uk/.
21. Kosiborod M. Dapagliflozin in Respiratory Failure in Patients With COVID-19 (DARE-19) [Internet]. Disponible en: https://www.clinicaltrials.gov/ct2/show/NCT04350593.
22. Tsai S, Clemente-Casares X, Zhou AC, Lei H, Ahn JJ, Chan YT, et al. Insulin receptor-mediated stimulation boosts T cell immunity during inflammation and infection. Cell Metab. 2018;28(6):922-934.e924. doi: 10.1016/j.cmet.2018.08.003.
23. Hansen TK, Thiel S, Wouters PJ, Christiansen JS, Van den Berghe G. Intensive insulin therapy exerts antiinflammatory effects in critically ill patients and counteracts the adverse effect of low mannose-binding lectin levels. J Clin Endocrinol Metab. 2003;88(3):1082-8. doi: 10.1210/jc.2002-021478.

Diabetes Mellitus
Covid-19
Tratamiento