Diabetes mellitus and multiple myeloma; common features of two distinct entities

Abstract

Diabetes mellitus (DM) has attained the status of a global pandemic. Cardiovascular disease (CV) was the leading cause of morbidity in people with type 2 DM, however, a transition from CV to cancer as the leading contributor to DM related death has been observed lately. Multiple myeloma (MM) is the second most common haematological malignancy. Obesity is a common risk factor for both DM and MM. Although data are limited, studies have shown that DM might be associated with increased risk for the development of MM. The presence of DM might affect the course of patients with MM, since hyperglycemia may have an impact on both the efficacy and the adverse effects of antimyeloma therapy. In parallel, DM and MM share common clinical presentations, such as nephropathy, neuropathy, and CV. In terms of antidiabetic medications, metformin might present a synergistic effect with antimyeloma drugs and also prevent some of the adverse effects of these drugs; pioglitazone might have favourable effects when given as add on treatment in people with relapsed or refractory MM. No clinically important interactions have been observed between antidiabetic agents and the most commonly used antimyeloma drugs. Further data are needed to examine the effect of all classes of antidiabetic medication on MM and its complications. A baseline assessment of risk factors for glucose intolerance and close monitoring of glucose levels during therapy is strongly suggested for patients with MM.

Metformin and risk of hematological cancers in patients with diabetes: a systematic review and meta-analysis

“… 45 – 47 Insulin resistance is also a common feature of patients with T2DM and has been linked to an increased risk of various types of HCs, including MM. 48 By reducing insulin resistance and lowering insulin and glucose levels, metformin may help to create an unfavorable environment for the growth and survival of HCs cells. Metformin may also impact the tumor microenvironment by promoting an anti-inflammatory phenotype.…”

Monoclonal Gammopathy of Undetermined Cardiovascular Significance; Current Evidence and Novel Insights

“…Although DM might be associated with the development of MM [16] and DM may be an adverse prognostic factor for overall survival in patients with MM [17], data linking DM and MGUS are limited, with conflicting conclusions due to the overlapping effect of obesity [18]. A population-based matched case-control study in Sweden, with 94,579 cases and 368,348 controls, aimed to examine the association between DM and plasma cell dyscrasias as well as lymphoproliferative disorders [19].…”

Thiazolidinedione Use Is Associated with a Borderline Lower Risk of Multiple Myeloma and a Significantly Lower Risk of Death in Patients with Type 2 Diabetes Mellitus in Taiwan

“…MM is the second most common hematological malignancy after lymphoma [2] and the most common clinical manifestations are hypercalcemia, renal failure, anemia and lytic bone lesions [1]. MM can be associated with some gene mutations, and epidemiological studies have shown its links with aging, male sex, obesity, diabetes mellitus and metabolic syndrome [1,[3][4][5][6][7][8][9]. Dioxin exposure [10,11] and ionizing radiation [12] can also be risk factors but smoking is not [13].…”