COVID-19 and steroid therapy: Impact on diabetes

We read an interesting article by Papadokostaki et al. in a recent issue of the Primary Care Diabetes regarding the evolving relationship of COVID-19 and diabetes mellitus []. Understanding this bidirectional relationship is essential for optimizing long term patient outcomes []. Authors have highlighted the common challenges faced for the same during this pandemic. In this regard, we would like to add another issue of the use of steroid therapy for moderate to severe disease, leading to worsening of hyperglycemia and precipitating ketoacidosis. In our clinical practice, we have noticed this happening while patients are presenting to tertiary care hospital from peripheral hospitals, where they have been initiated on steroid therapy. As per data from other countries as well, the use of steroids is common for moderate to severe COVID-19 despite the conflicting evidence. The recent data from RECOVERY (Randomised Evaluation of COVid-19 thERapY) trial regarding the usefulness of dexamethasone therapy is encouraging but is likely to affect glycemic control in individuals with diabetes or hyperglycemia due to COVID-19 [,]. The initial published results have not described the impact of steroid therapy on glycemic control []. As we are awaiting the full results of the RECOVERY trial, it is prudent to keep a watch on glycemic control in patients being initiated on dexamethasone therapy, especially elderly and diabetic individuals.