Ведення пацієнтів з цукровим діабетом 2-го типу до, під час та після зараження Covid-19: які докази існують?
DOI: https://doi.org/10.1186/s12933-021-01389-1
Лешек Чуприняк, Дрор Дікер, Роджер Леманн, Мартін Празні, Гунтрам Шернтанер
Резюме
Захворюваність пацієнтів інфекцією Covid-19 ставить лікарів перед новими проблемами лікування цукрового діабету 2-го типу, включно з питанням про те, чи слід коригувати глюкозознижуючу терапію під час захворювання та як повертатись до нормального лікування після усунення симптомів Covid-19. У зв’язку з раптовим початком пандемії лікарі були змушені приймати важливі клінічні рішення за выдсутності найдійних доказів або послідовних рекомендацій. Ризик для пацієнтів посилюється поширеністю серцево-судинних захворювань у цій популяції, які разом з цукровим діабетом є основним фактором ризику тяжкого перебігу і смерті від Covid-19. Ми зібрались як експерти з регіону Центральної та Східної Європи, щоб сформулювати поради, які ми можемо надати в контексті цукрового діабету 2-го типу та Covid-19, враховуючи дані, отримані у пацієнтів до, під час та після зараження. Ми розглянули рекомендації, які були опубліковані на сьогоднішній день, і оцінили доступні, але наразі обме- жені дані великих спостережних досліджень та рандомізованого контрольного дослідження DARE-19. Слід зазначити, що ми виявили відсутність рекомендацій щодо оптимальної цукрознижуючої терапії після одужання від Covid-19, і припустили, що це може дати можливість оптимізувати лікування та протидіяти клінічній інерції, яка передувала пандемії. Крім того, ми наголошуємо, що оптимізація стосується не лише контролю глікемії, а й інших факторів, таких як серцево-нирковий захист. Хоча ми з нетерпінням чекаємо на появу нових доказів, які, як ми сподіваємось, дозволять усунути ці прогалини, виходячи з нашого сукупного клінічного досвіду, ми одночасно описуємо можливі підходи до керування глюкозознижуючою терапією в ситуації, коли пацієнти з Covid-19 одужують і повертаються до свого стандартного лікування.
Ключові слова: Covid-19, цукровий діабет 2-го типу, глюкозознижуюча терапія
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