Diabetes in Cancer Patients: Risks, Goals and Management

Diabetes mellitus (DM) is commonly found in cancer patients. The relationship between DM and cancer appears to be bidirectional: DM has been associated with an increased risk of developing several types of cancer while also cancer treatments, through the induction of metabolic derangements, can facilitate the onset of DM, or worsen glucose control. In particular, novel antineoplastic treatments such as immunotherapy and targeted therapies have been associated with both acute and long-term metabolic consequences. An adequate management of DM in cancer patients is pivotal, since DM can negatively affect the clinical outcomes of these subjects, being associated with worse survival. However, DM management in cancer patients may be challenging given the peculiarities of these conditions. Lower reliability of HbA1c, a thorough evaluation of the safety profile of antidiabetic drugs, and the need to adapt glycemic targets to patients' prognosis should be taken into consideration. Moreover, DM is commonly encountered also in the ever-growing population of cancer survivors, contributing to their increased cardiovascular risk. In conclusion, taking in consideration the lack of specific guidelines, the particular features of the condition, and the potential impact on prognosis, a multidisciplinary management of DM in cancer patients and survivors is warranted.