Glycaemic control in people with type 2 diabetes mellitus during and after cancer treatment: A systematic review and meta-analysis

Abstract

BackgroundCancer and Diabetes Mellitus (DM) are leading causes of death worldwide and the prevalence of both is escalating. People with co-morbid cancer and DM have increased morbidity and premature mortality compared with cancer patients with no DM. The reasons for this are likely to be multifaceted but will include the impact of hypo/hyperglycaemia and diabetes therapies on cancer treatment and disease progression. A useful step toward addressing this disparity in treatment outcomes is to establish the impact of cancer treatment on diabetes control.AimThe aim of this review is to identify and analyse current evidence reporting glycaemic control (HbA1c) during and after cancer treatment.MethodsSystematic searches of published quantitative research relating to comorbid cancer and type 2 diabetes mellitus were conducted using databases, including Medline, Embase, PsychINFO, CINAHL and Web of Science (February 2017). Full text publications were eligible for inclusion if they: were quantitative, published in English language, investigated the effects of cancer treatment on glycaemic control, reported HbA1c (%/mmols/mol) and included adult populations with diabetes. Means, standard deviations and sample sizes were extracted from each paper; missing standard deviations were imputed. The completed datasets were analysed using a random effects model. A mixed-effects analysis was undertaken to calculate mean HbA1c (%/mmols/mol) change over three time periods compared to baseline.ResultsThe available literature exploring glycaemic control post-diagnosis was mixed. There was increased risk of poor glycaemic control during this time if studies of surgical treatment for gastric cancer are excluded, with significant differences between baseline and 12 months (p < 0.001) and baseline and 24 months (p = 0.002).ConclusionWe found some evidence to support the contention that glycaemic control during and/or after non-surgical cancer treatment is worsened, and the reasons are not well defined in individual studies. Future studies should consider the reasons why this is the case.

Does a prostate cancer diagnosis affect management of pre-existing diabetes? Results from PCBaSe Sweden: a nationwide cohort study

“…Prostate Cancer database (PCBaSe) Sweden 3.0 is based on the National Prostate Cancer Register (NPCR) of Sweden, which became nationwide in 1998 and covers 98% of all newly diagnosed cases of PCa, as compared with the Swedish Cancer Register. 15 16 NPCR includes information on date of diagnosis, age at diagnosis, tumour stage and differentiation, serum levels of prostate-specific antigen at time of diagnosis. Using the Swedish personal identity number, five PCa-free men from the general population in Sweden were randomly selected within sets of men who matched the index case on birth year and county of residence and included in a PCa-free control cohort.…”

“…Using the Swedish personal identity number, five PCa-free men from the general population in Sweden were randomly selected within sets of men who matched the index case on birth year and county of residence and included in a PCa-free control cohort. 15 Both men with PCa and those in the control cohort were subsequently linked to a series of national healthcare registers and demographic databases, including the National Diabetes Register (NDR) and the Prescribed Drug Register (PDR). PCBaSe Traject includes all data in PCBaSe 3.0 but has additional linkages.…”

“…A recent meta-analysis of glycaemic control in subjects with T2DM during and after cancer treatment found mixed results, with four studies reporting no increase in haemoglobin A1c (HbA1c) and three studies reporting an increase in HbA1c after cancer treatment. 15 Of those three studies where glycaemic control worsened, two were in patients with PCa who had received ADT. 16 17 The largest study was by Keating et al, and it showed an increase in HbA1c at 1 and 2 years despite a 20% increased risk of receiving additional T2DM medications in men with PCa on GnRH agonists.…”

Changes in blood glucose of elderly patients with gastric cancer combined with type�2 diabetes mellitus after radical operation and the effect of mediation adjustment for blood glucose on the recovery of gastric cancer

“…Another recent meta-analysis in 2017 revealed that patients with T2DM treated with melbine have a lower risk of gastric cancer than those who were not treated with melbine ( 14 ). In addition, perioperative glycemic control can not only reduce the incidence rate of postoperative complications, but also can benefit patients in the long-term prognosis because early blood glucose control can delay the deterioration of tumor to some extent and improve the survival of patients ( 15 , 16 ). These studies are consistent with our conclusions.…”

Environmental factors and life style having an impact on pathogenesis and etiology of Diabetes Mellitus

“…Most people know little about the possible relationship between radiation exposure and diabetes (17). For example, among 8 articles including a systematic review and meta-analysis of 1863 T2DM patients reported by Pettit et al which identified and analyzed the current evidence on glycemic control (HbA1c) during and after cancer treatment, the effect of radiation on glycemic control is not mentioned (18). However, it has been considered by the International Commission for Radiation Protection as one factor involved in multifactorial diseases (19).…”