Control of type 2 diabetes in patients with cancer and chronic pro-inflammatory cytokines during the COVID-19 pandemic

TL;DR

This study examines how to manage diabetes in cancer patients with chronic inflammation during the pandemic using specific medications.

Contribution

The study identifies specific sulfonylureas for managing dysglycemia in cancer patients with severe COVID-19.

Findings

Gliquidone and glimepiride effectively managed central and peripheral insulin resistance in cancer patients with diabetes.

Azithromycin and anakinra treatment was associated with dysglycemia requiring sulfonylurea therapy.

Inflammatory markers like TNF-alpha and IL-6 were linked to cardiometabolic risks in treated patients.

Abstract

Patients with cancer and severe COVID-19 pneumonia treated with injectable azithromycin and anakinra frequently develop dysglycemia, necessitating initiation of sulfonylurea therapy (gliquidone or glimepiride). We retrospectively reviewed adults (≥30 years) with diabetes and cancer who were hospitalised for COVID-19 at the Central Military Hospital Bucharest and the Matei Bals National Institute between March 2020 and August 2022. All patients completed a 14-day course of azithromycin + anakinra and survived to discharge. Glycaemic control was achieved with fixed-dose gliquidone 30 mg or glimepiride 2, 3, or 6 mg, chosen according to each patient’s inflammatory-cardiac profile. Central insulin resistance may lead to the risk of cardiometabolic syndrome through the increase of inflammatory markers (TNF-alpha and PAI-1), treated with gliquidone, in 50 patients with cancer infected with COVID-19, who were dependent on developing immunothrombosis. Peripheral insulin resistance leads to the risk of cardiovascular events through the increase of inflammatory markers, IL-6 and Il-1, treated with glimepiride, in 50 patients with cancer infected with COVID-19.

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