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Diabetes Distilled: ACE inhibitors and ARBs, diabetes, hypertension and COVID-19

There has been concern in primary care and among people with diabetes and/or hypertension that renin–angiotensin system blockers may increase the risk of severe and fatal complications from COVID-19 infection. More recently, however, there have been a number of position statements from international bodies which highlight the lack of supporting evidence for the harmful effects of these drugs. The societies strongly recommend that we continue treatment with antihypertensive therapy.

Correspondence published online in early March hypothesised that people living with diabetes and/or hypertension treated with angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) were at increased risk of developing severe and fatal COVID-19 complications (Fang et al, 2020). Understandably, this caused great concern in primary care as these are commonly used drugs and, furthermore, because many individuals were stopping their therapy after reading about this on various social media channels.

Reassuringly, we have now had a number of position statements from international bodies, including the European Society of Cardiology Council on Hypertension and the Renal Association. These highlight the lack of supporting evidence for the harmful effects of these classes of drugs. The societies strongly recommend that we continue treatment with antihypertensive therapy.

We should, however, be mindful of those individuals at risk of acute kidney injury with acute dehydrating illness; on an individual basis, consider temporarily stopping these drugs to mitigate this risk. Importantly, we should remind individuals to restart their drugs once eating and drinking normally.

Other helpful resources
Diabetes UK: Coronavirus and diabetes. This regularly updated page is very helpful for those living with diabetes and their families and answers many commonly asked questions

JDRF: Coronavirus (COVID-19) – information for people living with type 1 diabetes. This regularly updated page contains useful links and information about coronavirus and what people living with type 1 diabetes need to know

NHS England & NHS Improvement London: Diabetes COVID-19 key information. Useful guidance to support the delivery of diabetes care during the pandemic. Guide for London Clinical Networks but there is plenty of helpful information for wherever we work

Primary Care Diabetes Society: COVID-19 and diabetes factsheet. This quick reference guide reviews a number of issues that healthcare professionals may need to consider when caring for people with diabetes

Diabetes & Primary Care: How to advise on sick day rules. A brief guide to managing diabetes during intercurrent illness

TREND-UK: Resources to help support nurses amid the coronavirus pandemic. Helpful patient information leaflets for those living with type 1 and type 2 diabetes and what to do when unwell

Fang L, Karakiulakis G, Roth M (2020) Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection? Lancet Respir Med 8: e21

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