Improvement of type 2 diabetes mellitus after gastric cancer surgery: Short-term outcome analysis after gastrectomy

An, Ji Yeong; Kim, Yoo Min; Yun, Min Ah; Jeon, Byeong Hee; Noh, Sung Hoon

doi:10.3748/wjg.v19.i48.9410

Cited by 32 publications

(50 citation statements)

References 10 publications

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“…We demonstrated that patients with long-term diabetes mellitus tended to have poor glycemic control after TP, and elderly patients might be subject to poor nutritional status. It is possible that insulin resistance is less severe in patients with a shorter duration of diabetes mellitus than in patients with a longer duration, as observed in gastrectomy[29]. On the other hand, functions of nutrient absorption and regulation are likely to diminish with previous alcohol history.…”

Section: Discussionmentioning

confidence: 99%

Impact of postoperative glycemic control and nutritional status on clinical outcomes after total pancreatectomy

Shi¹,

Jin²,

Fu³

2017

WJG

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AIMTo evaluate the impact of glycemic control and nutritional status after total pancreatectomy (TP) on complications, tumor recurrence and overall survival.METHODSRetrospective records of 52 patients with pancreatic tumors who underwent TP were collected from 2007 to 2015. A series of clinical parameters collected before and after surgery, and during the follow-up were evaluated. The associations of glycemic control and nutritional status with complications, tumor recurrence and long-term survival were determined. Risk factors for postoperative glycemic control and nutritional status were identified.RESULTSHigh early postoperative fasting blood glucose (FBG) levels (OR = 4.074, 95%CI: 1.188-13.965, P = 0.025) and low early postoperative prealbumin levels (OR = 3.816, 95%CI: 1.110-13.122, P = 0.034) were significantly associated with complications after TP. Postoperative HbA1c levels over 7% (HR = 2.655, 95%CI: 1.299-5.425, P = 0.007) were identified as one of the independent risk factors for tumor recurrence. Patients with postoperative HbA1c levels over 7% had much poorer overall survival than those with HbA1c levels less than 7% (9.3 mo vs 27.6 mo, HR = 3.212, 95%CI: 1.147-8.999, P = 0.026). Patients with long-term diabetes mellitus (HR = 15.019, 95%CI: 1.278-176.211, P = 0.031) and alcohol history (B = 1.985, SE = 0.860, P = 0.025) tended to have poor glycemic control and lower body mass index levels after TP, respectively.CONCLUSIONAt least 3 mo are required after TP to adapt to diabetes and recover nutritional status. Glycemic control appears to have more influence over nutritional status on long-term outcomes after TP. Improvement in glycemic control and nutritional status after TP is important to prevent early complications and tumor recurrence, and improve survival.

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Section: Discussionmentioning

confidence: 99%

Impact of postoperative glycemic control and nutritional status on clinical outcomes after total pancreatectomy

Shi¹,

Jin²,

Fu³

2017

WJG

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“…In addition to oncologic benefits, gastrectomy can also contribute to the improvement of glucose metabolism or remission of diabetes mellitus (DM) [5][6][7][8]. Interestingly, 1 study emphasized that the extent of the gastrectomy plays an important role in DM improvement after curative surgery for GC (total gastrectomy [TG] versus subtotal gastrectomy: 81.8% versus 36.2%, respectively, P = .007) [9].…”

mentioning

confidence: 96%

Total gastrectomy improves glucose metabolism on gastric cancer patients: a nationwide population-based study

Yang

et al. 2016

Surgery for Obesity and Related Diseases

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“…Papers described as being of moderate quality failed to provide sufficient detail on the patients’ cancer such as type and stage [30,35], details of how patients were selected and why [35], how missing data was dealt with [30], or did not appropriately deal with confounding variables [31]. …”

Section: Resultsmentioning

confidence: 99%

“…Poorer adherence to diabetic medications post-cancer diagnosis was described in three studies and patients reported they either ceased taking DM medications [35], or reduced DM medications use after diagnosis [31,35]; and this supports findings from the study by Zanders and colleagues [21]. An explanation for this may be that little attention is paid to glycaemic control by cancer health professionals and/or poorer self-management by the patients themselves when also burdened with the added responsibilities and strains associated with other competing chronic conditions [30] including cancer self-management [13], however evidence to support this is extremely limited.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2017

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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.

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Improvement of type 2 diabetes mellitus after gastric cancer surgery: Short-term outcome analysis after gastrectomy

Abstract: Diabetes improved in more than 50% of patients during the first year after gastric cancer surgery. The degree of diabetes control was related to diabetes duration.

Cited by 32 publications

References 10 publications

Impact of postoperative glycemic control and nutritional status on clinical outcomes after total pancreatectomy

Impact of postoperative glycemic control and nutritional status on clinical outcomes after total pancreatectomy

Total gastrectomy improves glucose metabolism on gastric cancer patients: a nationwide population-based study

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

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