Publication of May-June 2020

Diabetes is one of the most commonly reported comorbidities in COVID-19-infected patients. According to current data, diabetic patients do not appear to be at increased risk of contracting SARS-CoV-2 compared to the general population. However, diabetes is a risk factor for developing severe and critical COVID-19 forms, which often require intensive care unit admission and, eventually, invasive mechanical ventilation, which are associated with high mortality rates. The characteristics of COVID-19 diabetic patients and prognostic impact of diabetes on SARS-CoV-2 infection are currently under investigation. Obesity, the main risk factor for incident Type 2 diabetes, appears to be more common in patients with critical COVID-19 forms that require mechanical invasive ventilation. In diabetic patients, COVID-19 is associated with poor glycemic control and acute metabolic complications like ketoacidosis. At present, there are no recommendations in favor of discontinuing antihypertensive medications that interact with the renin-angiotensin-aldosterone system. Owing to the risks of lactic acidosis and ketoacidosis, metformin and SGLT2 inhibitors should be discontinued in patients with severe COVID-19 forms. Finally, we advise a systematic screening for (pre)diabetes in patients with proven SARS-CoV-2 infection.

From the beginning of the COVID-19 crisis, physicians alerted the scientific community to the emergence of severe acute respiratory problems related to viral lung infections. The vast majority of these patients require oxygen therapy and 5 to 10% need assisted ventilation or even extracorporeal membrane oxygenation in the event of an uncontrolled situation. Poor prognosis factors mainly include age, as well as the presence of comorbidities such as hypertension, diabetes, obesity, but also cardiovascular diseases. Coronaviruses are known to attack the cardiovascular system, and it also appears that the virus might attack the heart muscle directly. Data relayed namely by Chinese and Italian physicians show that besides the lungs, certain patients develop sometimes severe cardiac problems, such as acute myocarditis, acute coronary syndrome (ACS), or arrhythmias that in turn lead to heart failure, shock, or cardiac arrest in those most affected. Cardiac damage is therefore a factor contributing to the poor prognosis of COVID-19 and it must be detected. Patients who have an ACS but whose pulmonary picture prevails may have their cardiac management dangerously delayed. Conversely, patients who present with an exclusively "cardiological" picture may not be properly diagnosed as COVID-19. Finally, the focus on COVID-19 and the patients' fear of the contagiousness of this virus may delay their presentation at the hospital. These data directly impact the way physicians and hospitals should consider COVID-19 cardiac patients, especially at the first signs of the disease. It is therefore essential to have recommendations for the management of all patients with preexisting heart problems and those with demonstrated myocardial damage caused by the virus.