Heavy! The "Clinical Response Guidelines for Novel Coronavirus Infection in Elderly and Children and Adolescents with Diabetes" is here!

Abstract: Elderly diabetic patients need to strengthen blood glucose monitoring during the new crown virus infection (new crown infection), blood glucose management is relatively relaxed, in severe or critical patients, insulin therapy, and actively deal with the management of various comorbidities and complications; Children and adolescents with diabetes should be concerned about the occurrence
of diabetic ketoacidosis (DKA) and hypoglycemia during the new crown infection.
Maintaining a positive attitude, ensuring nutrition, monitoring blood glucose, and maintaining blood glucose stability are important clinical
responses.

Prevention and treatment of novel coronavirus infection (new crown infection) in people with "elderly diabetes"

As a special group, elderly diabetic patients have many underlying diseases, poor immune function, are susceptible to infection with the new coronavirus, and are more likely to develop severe and critical disease
after infection.
Effective monitoring and management of blood glucose and prevention and treatment of acute and chronic complications of diabetes are important clinical response goals
for these patients.

First, the basic treatment of elderly diabetic people

According to the patient's self-care ability, with the cooperation of family members, personalized life care, and strive to make the living environment ventilated and breathable
.

➤ Diet: Daily diet to ensure sufficient nutritional supply, encourage the intake of eggs, milk, fish, meat and other high-protein, grains, vegetables and fruits, etc.
, do not eat raw and cold foods
.
Low-sugar, low-salt, low-fat diet
.

At the same time, according to the patient's swallowing and chewing conditions, give crushed vegetables and rotten rice, half-flow, full-flow, or general food
.
Maintain a moderate amount of water every day, 1500-2000ml of water per day, advocate drinking boiled water and tea, and do not drink sugary drinks or syrup syrups
.

For patients with poor appetite or inadequate diet, enteral nutrition
can be encouraged with fortified foods, or formulated nutrient supplements, trace elements, and probiotics for special medical purposes.
In addition, try to avoid the occurrence
of aspiration during eating.

➤ Exercise: Encourage moderate activity and avoid prolonged bed
rest.
Care should be taken to prevent falls
when exercising.
For patients who are bedridden for a long time, it is encouraged to turn over regularly and perform physical rehabilitation exercises in bed to avoid skin problems
such as pressure injuries.
For patients at risk of deep vein thrombosis, lower extremities are elevated in the recumbent position and thromboprophylaxis is treated after exclusion of
contraindications.

Second, the blood sugar management of elderly diabetic people

1.
Blood sugar control goals

➤ Mild/ordinary elderly diabetic patients control the target fasting blood glucose of about 7mmol/L;

➤ Patients with severe/critical disease should be treated with inpatient blood glucose relaxation treatment goals, that is, fasting or preprandial blood glucose of 7.
8-10.
0 mmol/L, 2 hours after prandial or random blood glucose maintenance of 7.
8-13.
9 mmol/L
.
In severe patients, because the symptoms of hypoglycemia are often not obvious, random blood glucose should not be < 7.
8 mmol/L
.

2.
Selection of hypoglycemic scheme

Elderly diabetic patients with mild/common new crown infection need to adjust the hypoglycemic regimen according to the doctor's advice, and cannot stop or change the drug
without authorization.
Strictly grasp the contraindications
of hypoglycemic drugs.

➤Metformin can be used in ambulatory patients;

➤Sulfonylurea-lowering drugs are prone to cause hypoglycemia in elderly patients;

➤ Thiazolidinediones should be used with caution in patients with heart failure and liver insufficiency;

➤ Glinide drugs can be used in patients with renal insufficiency, but be alert to the risk of hypoglycemia;

➤ For patients with severe gastrointestinal dysfunction, α-glycosidase inhibitors should be used with caution;

➤ Dipeptide peptidase 4 inhibitors, except for lindagliptin, other drugs need to adjust the dose in patients with liver and kidney dysfunction;

➤SGLT-2 inhibitors should be used with caution due to potential capacity reduction risks;

➤In addition, glucagon-like peptide-1 receptor agonists are not conducive to nutrient absorption during new coronavirus infection because they are often accompanied by gastrointestinal symptoms, and need attention
.

For severe or critically ill patients who have been hospitalized, it is recommended to discontinue all oral hypoglycemic agents and use insulin therapy, including subcutaneous or intravenous
infusions.
The specific insulin dosage form, the dosage is determined by the endocrinologist
.

3.
Treatment of comorbidities and complications

Elderly diabetic patients are often accompanied by chronic complications of diabetes, obesity, hypertension, dyslipidemia, chronic bronchitis, coronary heart disease, sleep apnea syndrome and other underlying diseases
.
While adhering to drug treatment according to medical advice and strengthening comprehensive metabolic management, it is necessary to pay attention to the drug interaction between the treatment of new coronavirus infection and antihypertensive, lipid-lowering, antianginal drugs, antiarrhythmic drugs, antiplatelet and anticoagulant drugs and heart failure treatment drugs, and invite corresponding disciplines to assist in diagnosis and treatment
.

Older diabetic patients are prone to acute complications, particularly diabetic hyperosmolar states
, with poor glycemic control and inadequate fluid replacement.
Management of acute complications requires careful assessment of cardiac, pulmonary, and hepatic and renal function status
.
Considering that lung exudation can exacerbate hypoxemia during new coronavirus infection, conservative rehydration is preferred during management
.
Encourage active water
drinking.
If you are unable to actively drink water, it will be adjusted
according to the amount of water entering and leaving.
Hydration management of hyperosmolar states is limited
by preventing or slowing the onset of pulmonary edema.
At the same time, hypernatremic dehydration is associated with hypercoagulable states, especially in bedridden patients, where the risk of venous thrombosis and pulmonary embolism is significantly increased, and low molecular weight heparin needs to be used
under multidisciplinary guidance.

4.
Blood glucose monitoring

Encourage the practice of self-directed blood monitoring and continuous glucose monitoring, and pay attention to operational protection
when using blood glucose meters.

Corticosteroid use and irregular eating can lead to large fluctuations
in blood sugar.
In addition, elderly patients may have dawn and Somogy phenomenon, and blood glucose monitoring
needs to be strengthened.

In patients with stable blood glucose levels or only oral hypoglycemic therapy, fasting glucose monitoring 1-2 times a week is recommended; If receiving basal insulin therapy in patients, it is recommended to monitor fasting blood glucose 3-4 times a week; In patients receiving premixed insulin therapy, it is recommended to monitor blood glucose
on fasting and before dinner 3-4 times a week.
If necessary, increase nocturnal blood glucose testing; Patients receiving intensive insulin therapy or an insulin pump regimen are advised to develop a blood glucose monitoring regimen
under the guidance of a doctor.

3.
Strengthen medical humanistic care

Elderly diabetic patients have different degrees of sensory, motor and cognitive dysfunction, and are prone to anxiety, depression and other adverse emotions
.
It is recommended to pay attention to positive reports on weekdays, encourage family, friends and nursing staff to listen patiently, chat and communicate with them more, relieve tension, give encouragement and support, and maintain an optimistic and healthy attitude
.

Prevention and treatment of new crown infection in people with "childhood and adolescent diabetes"