# 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.

## Key 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.