Fig. 1

Recommendations and evidence for different classes of glucose-lowering drugs in patients with type 2 diabetes in a Covid-19 setting. A Recommendations for the management of type 2 diabetes in a Covid-19 setting have consistently advocated for the use of insulin (not shown) in patients hospitalized with severe Covid-19, but are less consistent in guidance for other glucose-lowering drug classes. Shown in this panel is the maximum severity of Covid-19 where various publications have recommended that metformin, SGLT2i, GLP-1 RA or DPP-4i can be continued in patients with type 2 diabetes. B Several large real-world studies have sought to compare mortality and other serious outcomes among glucose-lowering drugs in patients with Covid-19; however, these studies are limited by significantly different patient profiles between cohorts that may lead to confounding, even with the best efforts to control for biases. To avoid confounders, randomized controlled trials are need. One such study, DARE-19, has recently shown a trend towards positive outcomes with SGLT2i that was considered hypothesis generating, but was not statistically significant