Chemotherapy and glycemic control in patients with type 2 diabetes and cancer: A comparative case analysis

Hershey, Denise Soltow; Hession, Sarah

doi:10.4103/apjon.apjon_22_17

Cited by 26 publications

(27 citation statements)

References 24 publications

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“…[ 11 ] Cancer patients with diabetes also are at increased risk for developing infections and being hospitalized while undergoing treatment. [ 8 9 12 13 14 ]…”

Section: Treating Cancer and Diabetes: A Growing Issuementioning

confidence: 99%

“…The four studies found used different methods and designs: two were retrospective,[ 20 21 ] one was cross-sectional,[ 22 ] and one was longitudinal. [ 14 ] In addition, there was little consistency in how glycemic control was measured across studies. While three studies used glycated hemoglobin (HbA1c), the timing of HbA1c measurements varied.…”

Section: Glycemic Control During Treatmentmentioning

confidence: 99%

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Importance of glycemic control in cancer patients with diabetes: Treatment through end of life

Hershey

2017

Asia-Pacific Journal of Oncology Nursing

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Cancer patients with diabetes are at increased risk for developing infections, being hospitalized, and requiring chemotherapy reductions or stoppages. While it has been hypothesized that glycemic control increases the risk for these adverse events, few studies have explored this hypothesis. The purpose of this paper is to discuss the importance of glycemic control in patients with diabetes and cancer during treatment through end of life. Glycemic control was found to play a role; the overall level of health-related quality of life experienced by patients with cancer and diabetes, level of symptom severity experienced and can impact the overall survival of the individual. Evidence-based policies and practice guidelines also need to be developed to help clinicians manage these patients during all phases of care. Using diabetes educators and advance practice, nurses to provide management and care coordination services need to be considered. Survivorship care plans should address both cancer and diabetes management. Finally, glycemic control should continue through end of life, with the main goal of avoiding hypoglycemic events.

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“…[ 11 ] Cancer patients with diabetes also are at increased risk for developing infections and being hospitalized while undergoing treatment. [ 8 9 12 13 14 ]…”

Section: Treating Cancer and Diabetes: A Growing Issuementioning

confidence: 99%

Section: Glycemic Control During Treatmentmentioning

confidence: 99%

Importance of glycemic control in cancer patients with diabetes: Treatment through end of life

Hershey

2017

Asia-Pacific Journal of Oncology Nursing

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“…To our knowledge, the 4 studies that have investigated diabetes management patterns found that glucose control, medication adherence, and self-management behaviors declined after a cancer diagnosis. [11][12][13][14] However, these studies were limited to individuals undergoing chemotherapy, [12][13][14][15] measured glucose at the time of cancer diagnosis but not after the initiation of cancer treatment, 13 and had very small sample sizes. 14,15 The objective of the current study was to describe patterns of diabetes management among patients with cancer in the year before and after diagnosis.…”

Section: Introductionmentioning

confidence: 99%

“…[11][12][13][14] However, these studies were limited to individuals undergoing chemotherapy, [12][13][14][15] measured glucose at the time of cancer diagnosis but not after the initiation of cancer treatment, 13 and had very small sample sizes. 14,15 The objective of the current study was to describe patterns of diabetes management among patients with cancer in the year before and after diagnosis. Using the large, population-based Surveillance, Epidemiology, and End Results (SEER) cancer registry linked to Medicare fee-for-service claims (SEER-Medicare) data, we sought to determine patterns of diabetes management (ie, hemoglobin A1c [HbA1C] testing, screening for diabetic retinopathy, and low-density lipoprotein [LDL] testing) for patients with breast, prostate, and colorectal cancer in the 12 months before and after a cancer diagnosis.…”

Section: Introductionmentioning

confidence: 99%

Diabetes care management patterns before and after a cancer diagnosis: A SEER‐Medicare matched cohort study

Pinheiro

Soroka

Kern

et al. 2020

Cancer

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Background Diabetes places patients with cancer at an increased risk of infections, hospitalizations, and mortality. The objective of the current study was to characterize diabetes care management patterns among patients with cancer in the year before and, separately, after cancer diagnosis. The authors hypothesized that diabetes care declines after a diagnosis of cancer. Methods The Surveillance, Epidemiology, and End Results (SEER) cancer registry linked to Medicare claims data was used. The authors included diabetic beneficiaries aged ≥65 years who were diagnosed with incident, nonmetastatic breast, prostate, or colorectal cancer between 2008 and 2013. Controls were diabetic Medicare beneficiaries in SEER regions who did not have cancer. Cases were matched to controls based on age, sex, Charlson Comorbidity Index, and diabetes severity. Primary outcomes were diabetes care received over 12 months: 1) hemoglobin A1c testing; 2) eye examination; and 3) low‐density lipoprotein testing. Using a difference‐in‐difference (DID) approach, the authors examined use differences 12 months before to after diagnosis for patients with cancer and controls. To avoid capturing testing related to diagnosis and not diabetes management, the authors implemented a 90‐day washout period (45 days before and/or after diagnosis). Results A total of 32,728 diabetic patients with cancer and 32,728 matched noncancer controls were included. After diagnosis, patients with cancer were found to have modest, but significantly lower, rates of diabetes care use compared with controls. Patients with cancer had greater declines in hemoglobin A1c testing (DID, 2.4%; 95% CI, 1.7%‐3.0%), low‐density lipoprotein testing (DID, 4.3%; 95% CI, 3.6%‐5.0%), and receipt of all diabetes indicators (DID, 2.7%; 95% CI, 1.8%‐3.5%) 12 months before to after diagnosis. Conclusions Compared with controls, less diabetes care use was observed among patients with cancer in the year after diagnosis. Understanding and addressing the reasons for this may improve outcomes in this population.

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“…These side effects have been reported in a wide variety of patients, especially cancer patients with diabetes [1,2]. Several studies have demonstrated that patients with concomitant diabetes and cancer have a poorer prognosis than those without diabetes [3,4]. It is reasonable to speculate that a cancer patient with diabetes is more susceptible to Dox-induced cardiotoxicity.…”

Section: Introductionmentioning

confidence: 99%

Dapagliflozin Protects Doxorubicin-induced Cardiotoxicity in Breast Cancer Patients With Diabetes via Suppressing ER Stress

Chang¹,

Lin²,

Ho³

et al. 2020

Preprint

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Background: Cancer patients with diabetes have an increasing risk of Dox-induced cardiotoxicity. Despite previous studies reporting benefits of dapagliflozin on the cardiovascular system, it remains unknown whether dapagliflozin has a cardioprotective effect in cancer patients with diabetes receiving Dox therapy. The purpose of this study was to investigate the potential of dapagliflozin for preventing doxorubicin (Dox)-induced cardiotoxicity.Methods: Using Taiwan National Health Insurance Database, the incidence of heart failure of cancer patients with or without diabetes was investigated. Streptozotocin (STZ)-induced diabetic rats were pretreated with oral dapagliflozin (10 mg/kg/day) for 6 weeks followed by Dox (5 mg/kg/week) for 4 weeks via intraperitoneal injection. Sequential echocardiography was applied to assess cardiac function. For in vitro analysis, cardiomyocytes cultured in high glucose (30 mM) were treated with dapagliflozin at 10 M and subsequently exposed to Dox at 1 M. Apoptosis and endoplasmic reticulum (ER) stress-related protein expression were measured by immunohistochemistry and Western blotting.Results: Among the studied patients, those with diabetes had a higher risk of major adverse cardiovascular events including the development of heart failure. In diabetic rats, dapagliflozin reduced cardiac fibrosis and significantly improved cardiac function. Dapagliflozin effectively inhibited Dox-induced apoptosis and reactive oxygen species in cardiomyocytes under high glucose. Mechanistically, we showed that dapagliflozin decreased the cardiac expression of Bax and cleaved caspase 3 but increased Bcl-2. Dapagliflozin also significantly reduced ER stress-associated proteins including GRP78, PERK, eIF-2, ATF-4, and CHOP. Conclusions: Our study revealed for the first time that dapagliflozin mitigated Dox-induced cardiomyocyte apoptosis in diabetes via inhibiting ER stress. These results indicate that dapagliflozin could be useful for preventing cardiotoxicity in diabetic cancer patients receiving Dox treatment.

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Chemotherapy and glycemic control in patients with type 2 diabetes and cancer: A comparative case analysis

Cited by 26 publications

References 24 publications

Importance of glycemic control in cancer patients with diabetes: Treatment through end of life

Importance of glycemic control in cancer patients with diabetes: Treatment through end of life

Diabetes care management patterns before and after a cancer diagnosis: A SEER‐Medicare matched cohort study

Dapagliflozin Protects Doxorubicin-induced Cardiotoxicity in Breast Cancer Patients With Diabetes via Suppressing ER Stress

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