Effect of empagliflozin in patients with type 2 diabetes during Ramadan on volume status, ketonaemia, and hypoglycaemia.

BACKGROUND AND AIMS: Patients with type 2 diabetes (T2D) carry higher risk of glycaemic variability during Ramadan. Glucose-lowering medications such as SGLT2 inhibitors are also associated with genitourinary infection, acute kidney injury, and euglycaemic diabetic ketoacidosis. Limited data is available on the effects of SGLT2 inhibitors on T2D patients during Ramadan. We investigated effects of empagliflozin use in fasting T2D patients. METHODS: This was a prospective cohort study in a single diabetes centre in Malaysia. Empagliflozin group were on study drug for at least three months. For control group, subjects not receiving SGLT2 inhibitors were recruited. Follow-up were performed before and during Ramadan fasting. Anthropometric measurements, blood pressure, renal profile, and blood ketone were recorded during visits. Hypoglycaemia symptoms were assessed via hypoglycaemia symptom rating questionnaire (HypoSRQ). RESULTS: We recruited a total of 98 subjects. Baseline anthropometry, blood pressure, and renal parameters were similar in two groups. No significant changes in blood pressure, weight, urea, creatinine, eGFR, or haemoglobin levels during Ramadan was found in either group. Likewise, no difference was detected in blood ketone levels (empagliflozin vs control, 0.17 ± 0.247 mmol/L vs 0.13 ± 0.082 mmol/L, p = 0.304) or hypoglycaemia indices (empagliflozin vs control, 19.1% vs 16%, p = 0.684). CONCLUSIONS: Ramadan fasting resulted in weight loss and reduction in eGFR levels in patients with T2D. Empagliflozin use during Ramadan is safe and not associated with increased risk of dehydration, ketosis, or hypoglycaemia. Therefore, empagliflozin is a viable glucose-lowering drug for patients with T2D planning for Ramadan fasting.

Recurrent Hypoglycaemia In An Older Individual With Covid-19.

Coronavirus disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged as a deadly pandemic overburdening healthcare system globally. While people of all ages were affected, the older population has faced disproportionately higher morbidity and mortality, likely due to altered immune responses and pre-existing comorbid conditions like cardiovascular disease, hypertension, diabetes mellitus, chronic pulmonary and kidney disease. Clinical manifestations in older patients may also be atypical with absence of fever, increased chances of acute confusion and longer recovery times. While other parameters of disease severity have been found, poor glycaemic control is another indicator of severity in COVID 19 infection. Moreover, older patients with diabetes mellitus are also at risk of hypoglycaemia which increases the risk of cardiovascular and cerebrovascular events, progression of dementia, falls, emergency department visits and hospitalization. Here we share a case of an older man with COVID-19 infection who presented primarily with recurrent hypoglycaemia and weakness. This case also highlights the social impact of an infection that has decimated support systems for vulnerable older adults.

Effectiveness of a flash glucose monitoring systems implementation program through a group and telematic educational intervention in adults with type 1 diabetes

Objectives: Verifying the clinical effectiveness and the impact on quality-of-life parameters, fear of hypoglycaemia and satisfaction with the treatment obtained with a flash glucose monitoring (MFG) devices implantation program that includes a telematic and group educational intervention in adults with type 1 diabetes. Patients and Methods: Prospective quasi-experimental study, carried out during the COVID-19 pandemic period with a 9-month follow-up at the Virgen Macarena University Hospital, Sevilla. Result(s): Eighty-eight participants were included (men: 46.6%;mean age (years) 38.08, SD: 9.38);years of DM1 evolution: 18.4 (SD: 10.49);treatment with multiple doses insulin (MDI) 70.5% vs 29.5% subcutaneous insulin infusion therapy (CSII)). Baseline HbA1c was 7.74% (1.08). After the intervention, the global decrease in HbA1c was -0.45% (95% CI [-0.6, -0.25], P<.01), increasing to -1.08% in the group that started with HbA1c>=8% (P<.01). A mean decrease in the Fear of Hypoglycemia 15 (FH15) test score of -6.5 points was observed (P<.01). In the global score of the spanish version of Diabetes Quality Of Life (DQOL-s) test, the decrease was -8.44 points (P<.01). In Diabetes Treatment Satisfaction Questionnaire test (DTQ-s), global score increased in + 4 points (P<.01). Conclusion(s): The incorporation of an educational program in group and telematic format within the development of MFG devices implantation strategies is an effective option, with associated benefits in quality of life and fear of hypoglycemia in adult patients with DM1. This option can be implemented in usual clinical practice. Copyright © 2021 SEEN y SED

Effectiveness of a flash glucose monitoring systems implementation program through a group and telematic educational intervention in adults with type 1 diabetes.

OBJECTIVES: Verifying the clinical effectiveness and the impact on quality-of-life parameters, fear of hypoglycaemia and satisfaction with the treatment obtained with a flash glucose monitoring (MFG) devices implantation program that includes a telematic and group educational intervention in adults with type 1 diabetes. PATIENTS AND METHODS: Prospective quasi-experimental study, carried out during the COVID-19 pandemic period with a 9-month follow-up at the Virgen Macarena University Hospital, Sevilla. RESULTS: Eighty-eight participants were included (men: 46.6%; mean age (years) 38.08, SD: 9.38); years of DM1 evolution: 18.4 (SD: 10.49); treatment with multiple doses insulin (MDI) 70.5% vs 29.5% subcutaneous insulin infusion therapy (CSII)). Baseline HbA1c was 7.74% (1.08). After the intervention, the global decrease in HbA1c was -0.45% (95% CI [-0.6, -0.25], P < 0.01), increasing to -1.08% in the group that started with HbA1c ≥ 8% (P < 0.01). A mean decrease in the Fear of Hypoglycemia 15 (FH15) test score of -6.5 points was observed (P < 0.01). In the global score of the Spanish version of Diabetes Quality Of Life (DQOL-s) test, the decrease was -8.44 points (P < 0.01). In Diabetes Treatment Satisfaction Questionnaire test (DTQ-s), global score increased in + 4 points (P < 0.01). CONCLUSIONS: The incorporation of an educational program in group and telematic format within the development of MFG devices implantation strategies is an effective option, with associated benefits in quality of life and fear of hypoglycemia in adult patients with DM1. This option can be implemented in usual clinical practice.

Acute complications of diabetes mellitus - proper diabetes education

The incidence and mortality of diabetic ketoacidosis (DKA) have hardly changed in recent years. Recurrent DKA in particular is characterised by a high mortality rate of about 23%. Young people with type 1 diabetes are more often hospitalised for DKA than for severe hypoglycaemia. COVID-19 probably leads to a higher incidence of DKA - especially in people with type 2 diabetes. Major risk factors for recurrent DKA include female gender, age between 13 and 25 years, higher HbA (1c) , migrant background and mental illness. Education on DKA should create awareness of the dangers of DKA and develop a concrete plan of action in case of emergency. Hypoglycaemia is the limiting factor of insulin therapy and is associated with increased diabetes-related distress and increased risk of cardiovascular events. The incidence of severe hypoglycaemia over 12 months is around 8%. The effective use of diabetes technologies should be an integral part of diabetes education. The most important technology-related education content includes alarm setting limits, the correct use of trend arrows, training in pattern recognition in the ambulatory glucose profile (AGP) and knowledge of automatic (predictive) low glucose suspend functions in automated insulin delivery (AID) systems. Hypoglycaemia unawareness occurs when the body becomes accustomed to low glucose levels and the autonomic response to low glucose levels weakens. The basis of hypoglycaemia-awareness training is systematic self-observation of one's own physical symptoms at different glucose levels.

Glycaemic management in patients with diabetes in hospital

The prevalence of diabetes mellitus in hospital inpatients is up to three times greater than in the general population. Furthermore, both hyperglycaemia and hypoglycaemic in the inpatient environment are associated with not only considerable increases in morbidity and mortality, but also increases in costs related to healthcare delivery. Clinical guidelines to improve glycaemic control in inpatient diabetes care vary regionally;in many countries, oral hypoglycaemic drugs are replaced by insulin-based treatment protocols, while in the UK consensus-based recommendations support the use of oral agents such as metformin and sulfonylureas in specific scenarios. Growing evidence supports the use of incretin-based therapies. Challenges during the continuing coronavirus disease (COVID-19) pandemic have further necessitated transformations in the delivery of diabetes care during hospital admissions and reinforced the adoption of technology associated with remote inpatient diabetes management. This overview of inpatient diabetes management focuses on current practices in the UK and gives recommendations for improving diabetes care, including the choice of various diabetes therapies and technologies.

Risk Factors of Hypoglycaemia in Prae-Covid-19 Era

Introduction: Clinically significant hypoglycaemia is considered to be an independent factor for mortality and morbidity in patients with diabetes mellitus. In our study we try to determine the risk factors of such hypoglycaemia by retrospective analysis of a cohort of patients. Study design and methods: The cohort consists of 1108 diabetic patients ranging in age from 19 to 93 years, mean age 56.99 years (standard deviation = 15.67), of whom 444 (40.07%) were type 1 diabetics and 664 (59.93%) were type 2 diabetics, and of the total number of patients, 585 (52.8%) were females and 523 (47.2%) were males. We divided the cohort into groups according to the presence of clinically significant hypoglycaemia during the course of hospitalization according to the American Diabetes Association 2021 criteria. Subsequently, we subjected the data regarding treatment, comorbidities, anthropometric and laboratory parameters of patients from each group to Welch’s t-test. Results: In our cohort, clinically significant hypoglycaemia was present more frequently in younger patients, predominantly with type 1 diabetes mellitus, longer duration of diabetes mellitus, lower Body Mass Index, and lower insulin resistance as expressed by the ratio of triacylglycerols to high-density lipoproteins. Treatment showed a trend towards a higher risk of hypoglycaemia with intensified insulin regimens versus less intensive treatments. The other comorbidities assessed and their treatment did not prove to be risk-increasing factors for hypoglycaemia in our cohort. Conclusion: According to our results, age, type of diabetes mellitus and its duration, low Body Mass Index and intensification of insulin regimen are the main risk factors for clinically significant hypoglycaemia. © 2021. All Rights Reserved.

Glycated haemoglobin levels among 3295 hospitalized COVID-19 patients, with and without diabetes, and risk of severe infection, admission to an intensive care unit and all-cause mortality.

AIM: To determine the risk of adverse outcomes across the spectrum of glycated haemoglobin (HbA1c) levels among hospitalized COVID-19 patients with and without diabetes. MATERIALS AND METHODS: Danish nationwide registries were used to study the association between HbA1c levels and 30-day risk of all-cause mortality and the composite of severe COVID-19 infection, intensive care unit (ICU) admission and all-cause mortality. The study population comprised patients hospitalized with COVID-19 (3 March 2020 to 31 December 2020) with a positive polymerase chain reaction (PCR) test and an available HbA1c ≤ 6 months before the first positive PCR test. All patients had at least 30 days of follow-up. Among patients with diabetes, HbA1c was categorized as <48 mmol/mol, 48 to 53 mmol/mol, 54 to 58 mmol/mol, 59 to 64 mmol/mol (reference) and >64 mmol/mol. Among patients without diabetes, HbA1c was stratified into <31 mmol/mol, 31 to 36 mmol/mol (reference), 37 to 41 mmol/mol and 42 to 47 mmol/mol. Thirty-day standardized absolute risks and standardized absolute risk differences are reported. RESULTS: We identified 3295 hospitalized COVID-19 patients with an available HbA1c (56.2% male, median age 73.9 years), of whom 35.8% had diabetes. The median HbA1c was 54 and 37 mmol/mol among patients with and without diabetes, respectively. Among patients with diabetes, the standardized absolute risk difference of the composite outcome was higher with HbA1c < 48 mmol/mol (12.0% [95% confidence interval {CI} 3.3% to 20.8%]) and HbA1c > 64 mmol/mol (15.1% [95% CI 6.2% to 24.0%]), compared with HbA1c 59 to 64 mmol/mol (reference). Among patients without diabetes, the standardized absolute risk difference of the composite outcome was greater with HbA1c < 31 mmol/mol (8.5% [95% CI 0.5% to 16.5%]) and HbA1c 42 to 47 mmol/mol (6.7% [95% CI 1.3% to 12.1%]), compared with HbA1c 31 to 36 mmol/mol (reference). CONCLUSIONS: Patients with COVID-19 and HbA1c < 48 mmol/mol or HbA1c > 64 mmol/mol had a higher associated risk of the composite outcome. Similarly, among patients without diabetes, varying HbA1c levels were associated with higher risk of the composite outcome.

Efectividad de un programa de implantación de sistemas de monitorización flash de glucosa a través de una intervención educativa grupal y telemática en adultos con diabetes tipo 1

Resumen Objetivo Comprobar la efectividad clínica y la repercusión sobre los parámetros de calidad de vida, miedo a hipoglucemias y satisfacción con el tratamiento obtenidas con un programa de implantación de sistemas de monitorización intermitente o tipo flash de glucosa (MFG) que incluye una intervención educativa telemática y grupal en adultos con diabetes mellitus tipo 1 (DM1). Material y métodos Estudio cuasiexperimental prospectivo, realizado durante el período de pandemia COVID-19 con un seguimiento de 9 meses en el Hospital Universitario Virgen Macarena, Sevilla. Resultados Se analizaron 88 participantes (varones: 46,6%;edad media: 38,08 años (desviación estándar [DE]: 9,38);tiempo de evolución DM1: 18,4 años (DE: 10,49);tratamiento con múltiples dosis de insulina (MDI) 70,5 vs. 29,5% bombas de infusión subcutánea continua de insulina (ISCI)). HbA1c basal del 7,74% (DE: 1,08). Tras la intervención el descenso global de HbA1c fue del −0,45% (p<0,01), aumentando a −1,08% en el grupo que partía con HbA1c≥8% (p<0,01). El descenso medio en la puntuación del test Fear of Hypoglycaemia (FH15) fue de −6,5 puntos (p<0,01), en el test Diabetes Quality of Life en español (EsDQOL): −8,44 puntos (p<0,01), y en el test Diabetes Treatment Satisfaction Questionnaire (DTQ-s): +4 puntos (p<0,01). No se registraron eventos adversos locales ni complicaciones agudas o crónicas de la diabetes durante el seguimiento. Conclusión La incorporación de un programa educativo en formato grupal y telemático sobre el uso de dispositivos de MFG dentro del desarrollo de estrategias de implantación de estos sistemas es una opción efectiva y con beneficios asociados en calidad de vida y miedo a hipoglucemias, implementable en la práctica clínica habitual en pacientes adultos con DM1. Objectives Verifying the clinical effectiveness and the impact on quality-of-life parameters, fear of hypoglycaemia and satisfaction with the treatment obtained with a flash glucose monitoring (MFG) devices implantation program that includes a telematic and group educational intervention in adults with type 1 diabetes. Patients and methods Prospective quasi-experimental study, carried out during the COVID-19 pandemic period with a 9-month follow-up at the Virgen Macarena University Hospital, Sevilla. Results Eighty-eight participants were included (men: 46.6%;mean age (years) 38.08, SD: 9.38);years of DM1 evolution: 18.4 (SD: 10.49);treatment with multiple doses insulin (MDI) 70.5% vs 29.5% subcutaneous insulin infusion therapy (CSII)). Baseline HbA1c was 7.74% (1.08). After the intervention, the global decrease in HbA1c was −0.45% (95% CI [−0.6, −0.25], P<.01), increasing to −1.08% in the group that started with HbA1c≥8% (P<.01). A mean decrease in the Fear of Hypoglycemia 15 (FH15) test score of −6.5 points was observed (P<.01). In the global score of the spanish version of Diabetes Quality Of Life (DQOL-s) test, the decrease was −8.44 points (P<.01). In Diabetes Treatment Satisfaction Questionnaire test (DTQ-s), global score increased in +4 points (P<.01). Conclusions The incorporation of an educational program in group and telematic format within the development of MFG devices implantation strategies is an effective option, with associated benefits in quality of life and fear of hypoglycemia in adult patients with DM1. This option can be implemented in usual clinical practice.

Nursing interventions for people with type 1 diabetes and frequent hypoglycaemia.

Type 1 diabetes is a lifelong condition which affects all age ranges, for reasons unknown, and the UK has one of the highest incidences of this complex condition in the world. Type 1 diabetes is caused by autoimmune damage to the insulin-producing ß-cells found in the pancreatic islet cells, leading to severe insulin deficiency. People with diabetes need to achieve a target glyosylated haemoglobin level to avoid macro- and microvascular complications, but there is the associated risk of hypoglycaemic events. These can vary in severity and consequences but will likely always cause worry for the person living with diabetes. There are many risk factors and reasons to be explored when looking at hypoglycaemia. This case study explores the nursing interventions that can be safely worked through and prioritised, within the community setting, to allow people with diabetes to be safe from severe hypoglycaemia, thus improving their quality of life and safety, as well as reducing costs for the NHS.

Diabetes Care During Hajj.

Diabetes mellitus affects over 463 million individuals worldwide. Religious activities such as the Hajj pilgrimage have a major impact on patients with diabetes mellitus, including increasing the risk of hyperglycaemia and hypoglycaemia. This increased risk is due to dietary changes and intense physical activity during pilgrimage while being on antidiabetic medications. Approximately 20% of the pilgrims with underlying illnesses who visit Mecca are diabetic, and complications, such as diabetic ketoacidosis, nonketotic hyperosmolar state, and fatigue/unconsciousness due to hypoglycaemia, have been observed among these patients. Diabetic patients are also at a high risk for foot complications and infections. To avoid any aggravation of the diabetes, a complete biochemical evaluation of the patient must be conducted before Hajj, and the patients must be provided contextualized educational guidance to avert these potential health challenges. This counselling should include the importance of carrying with them at all time their relevant medical history, summaries of the current treatment regimen and emergency snacks. In addition, to reduce the risk of hypoglycaemia, the dosage of insulin should be reduced in selected patients by 20% and that of sulfonylurea should be reduced as needed. Basal insulin and glucagon-like peptide 1 receptor agonists are associated with fewer complications and can be preferentially prescribed. Those patients with type 1 diabetes can continue with the use of insulin pump with suitable education prior to Hajj. For the prevention of foot problems, the use of padded socks and well-fitting shoes is recommended along with an insistence on not walking barefoot. After Hajj, the patient must be followed up, and necessary investigations must be made along with readjustment of insulin dosage in those patients for whom it was reduced. Until the pandemic situation abates, all diabetic patients should avoid making the Hajj journey.

High prevalence of Afro-Caribbean ethnicity and hypoglycaemia in patients with diabetes and end stage renal disease hospitalized with COVID-19.

End stage renal disease (ESRD) is associated with a high mortality rate among patients hospitalized with COVID-19. To the best of our knowledge, there is limited data on the clinical features, ethnicity, inpatient glycaemic control and outcomes in patients with diabetes related ESRD in the literature. We report the clinical features and outcomes of 39 consecutive ESRD patients (28 on haemodialysis [HD] and 11 with renal transplant) secondary to diabetic kidney disease admitted to a university hospital with COVID-19. We observed a high prevalence of patients of Afro-Caribbean ethnicity hospitalized with COVID-19 with a 73% and 54% prevalence in renal transplant and HD groups respectively. The mortality rate of our cohort was 36%. Nearly a one-third of HD patients and one-fifth of transplant patients had hypoglycaemic events during COVID-19 hospitalization. Adjustment of diabetes treatment was frequently required. Our data highlight the importance of integrated multidisciplinary care of patients with diabetes related ESRD hospitalized with COVID-19.

Management of glucose profile throughout strict COVID-19 lockdown by patients with type 1 diabetes prone to hypoglycaemia using sensor-augmented pump.

AIMS: Spain has been one of the worst affected countries by the COVID-19 pandemic. A very strict lockdown at home was imposed with a tough restriction of mobility. We aimed to evaluate the impact of this exceptional scenario on glucose profile of patients with type 1 diabetes (T1D) prone to hypoglycaemia using sensor-augmented pump (SAP). METHODS: Patients with T1D prone to hypoglycaemia using SAP (640G Medtronic-Minimed®) for at least 6 months under the funding of a National Health Service were included in an observational, retrospective study. Data were collected in two periods: pre-lockdown (PL), February 23rd-March 7th and within lockdown (WL), April 1st to 14th 2020. The primary outcome was the difference in the proportion of time in target glucose range of 70-180 mg/dL (TIR). Additional glucometric data and total daily insulin were also analysed. RESULTS: Fifty-nine patients were included: 33 women, age 46.17 ± 13.0 years and disease duration of 30.2 ± 12.0 years. TIR 70-180 mg/dL (67.6 ± 11.8 vs. 69.8 ± 12.0%), time > 180 (28.1 ± 13.6 vs. 25.5 ± 13.1%), time > 250 (6.9 ± 6.1 vs. 5.1 ± 4.8) and estimated HbA1c (6.94 ± 0.8 vs. 6.75 ± 0.7%) significantly improved (PL vs. WL, respectively, p < 0.05). Time in hypoglycaemia, coefficient of variation, sensor usage and total daily insulin dose remained unchanged. CONCLUSIONS: Lockdown conditions imposed by the COVID-19 pandemic may be managed successfully in terms of glycaemia control by population with DT1 prone to hypoglycaemia using SAP. The strict daily routine at home could probably explain the improvement in the time in glycemic target without increasing the time hypoglycaemia.

Reduction of hypoglycaemia, lifestyle modifications and psychological distress during lockdown following SARS-CoV-2 outbreak in type 1 diabetes.

AIMS: To assess changes in glucose metrics and their association with psychological distress and lifestyle changes in patients with type 1 diabetes (T1D) using flash glucose monitoring (FGM) during lockdown following severe acute respiratory syndrome coronavirus 2 outbreak. MATERIALS AND METHODS: Single-centre, observational, retrospective study enrolling T1D patients who attended a remote visit on April 2020 at the Endocrinology division of the University Hospital Policlinico Consorziale, Bari, Italy. Lockdown-related changes in physical activity level and dietary habits were assessed on a semi-quantitative basis. Changes in general well-being were assessed by the General Health Questionnaire-12 items with a binary scoring system. Glucose metrics were obtained from the Libreview platform for the first 2 weeks of February 2020 (T0) and the last 2 weeks before the phone visit (T1). RESULTS: Out of 84 patients assessed for eligibility, 48 had sufficient FGM data to be included in the analysis. FGM data analysis revealed significant reductions in coefficient of variation, number of hypoglycaemic events, and time below range, while no changes were found in time in range, time above range, mean sensor glucose, and glucose management indicator. Moreover, the frequency of sweets consumption was inversely related to the occurrence of hypoglycaemic events during lockdown. CONCLUSIONS: Lockdown-related lifestyle changes, albeit unhealthy, may lead to reduction in FGM-derived measures of hypoglycaemia and glycaemic variability in patients with T1D.

Newly diagnosed diabetes is associated with a higher risk of mortality than known diabetes in hospitalized patients with COVID-19.

AIM: To evaluate the association between different degrees of hyperglycaemia and the risk of all-cause mortality among hospitalized patients with COVID-19. MATERIALS AND METHODS: In a retrospective study conducted from 22 January to 17 March 2020, 453 patients were admitted to Union Hospital in Wuhan, China, with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 infection. Patients were classified into four categories: normal glucose, hyperglycaemia (fasting glucose 5.6-6.9 mmol/L and/or HbA1c 5.7%-6.4%), newly diagnosed diabetes (fasting glucose ≥7 mmol/L and/or HbA1c ≥6.5%) and known diabetes. The major outcomes included in-hospital mortality, intensive care unit (ICU) admission and invasive mechanical ventilation (IMV). RESULTS: Patients with newly diagnosed diabetes constituted the highest percentage to be admitted to the ICU (11.7%) and require IMV (11.7%), followed by patients with known diabetes (4.1%; 9.2%) and patients with hyperglycaemia (6.2%; 4.7%), compared with patients with normal glucose (1.5%; 2.3%), respectively. The multivariable-adjusted hazard ratios of mortality among COVID-19 patients with normal glucose, hyperglycaemia, newly diagnosed diabetes and known diabetes were 1.00, 3.29 (95% confidence interval [CI] 0.65-16.6), 9.42 (95% CI 2.18-40.7) and 4.63 (95% CI 1.02-21.0), respectively. CONCLUSION: We showed that COVID-19 patients with newly diagnosed diabetes had the highest risk of all-cause mortality compared with COVID-19 patients with known diabetes, hyperglycaemia and normal glucose. Patients with COVID-19 need to be kept under surveillance for blood glucose screening.

Case report of chloroquine therapy and hypoglycaemia in type 1 diabetes: What should we have in mind during the COVID-19 pandemic?

A type 1 diabetes patient experienced remission associated with chloroquine therapy while travelling to a malaria-endemic area. Chloroquine has immunomodulatory and hypoglycaemic effects and may become more frequently used due to the COVID-19 pandemic. Patients with type 1 diabetes treated with chloroquine should be monitored for hypoglycaemia, even after recovery.