Interactions between diabetes and COVID-19: A narrative review

Table 1 Use of antidiabetic medications in patients with type 2 diabetes and coronavirus disease 2019

	Insulin	Sulfonylurea	Metformin	DPP-4 inhibitors	SGLT-2is	GLP-1a
Benefits	Guarantee of achieving glycemic control; Cardiovascular neutrality; Possible use in multivisceral failure	Cardiovascular neutrality (demonstrated only with Glimepiride)	Probable cardiovascular benefit; No risk of hypoglycemia improvement of inflammation and endothelial dysfunction	Cardiovascular neutrality; Possible use in severe renal impairment and hypoxia; Possible inhibitory role on the entry of the virus into the cell; No risk of hypoglycemia	Proved cardiovascular and renal protective benefits; No risk of hypoglycemia Improvement of inflammation	Proved cardiovascular and renal protective benefits; Possibility of use up to the stage of severe renal failure; No risk of hypoglycemia; Improvement of inflammation and endothelial dysfunction
Risks	Increased glycaemic variability hypoglycaemic risks	Hypoglycaemic risk, contraindication in case of severe liver and renal failure	Multiple contraindications (hypoxia, severe renal failure, severe heart failure, severe liver failure); Risk of lactic acidosis especially in severe renal failure	Possible dysregulation of T cell function and T cell mediated inflammatory and immune responses	Reduced efficacy in moderate to severe renal impairment; Risk of ketoacidosis, especially in severe sepsis Risk of dehydration	Risk of digestive side effects; Risk of worsening undernutrition
Association with severe form of COVID-19 in observational studies	Conflicting results	Lower risk of severe form of COVID-19 or neutral association	Lower risk of severe form of COVID-19 or neutral association	Conflicting results	Lower risk of severe form of COVID-19 or neutral association	Neutral association
Medication use and severity of COVID-19 infection	Possibility of use at all stages of the disease and particularly in severe forms, especially recommended if blood sugar level is over 10-11 mM	Possible use up to moderate forms in the absence of severe renal and liver failure	Recommended use up to moderate forms in the absence of contraindications	Possible use up to moderate forms	Possible use up to moderate forms in the absence of moderate to severe renal failure	Possible use up to moderate forms

COVID-19: Coronavirus disease 2019; DPP-4: Dipepetidyl peptidase-4; SGLT-2is: Sodium-glucose cotransporter-2 inhibitors; GLP-1a: Glucagon like peptide-1 analogues.