Severe COVID-19 can lead to a ‘tremendous’ requirement for insulin in people with type 2 diabetes while those with type 1 disease are at risk of severe ketoacidosis, according to an international panel of endocrinologists.

Some 20 eminent specialists, including Professor Paul Zimmet from Monash University in Melbourne, offer tips for treating patients with diabetes and COVID-19 in a commentary in the Lancet Diabetes and Endocrinology.

“In general, people with all forms of diabetes are at increased risk of infection because of defects in innate immunity affecting phagocytosis, neutrophil chemotaxis and cell-mediated immunity,” the authors write.

To guard against severe disease, people with diabetes who have not yet caught SARS-CoV-2 should intensify metabolic control as a means of primary prevention, they advise. This includes adequate control of hypertension and lipids.