Serum glucose and hemoglobin A1C levels at cancer diagnosis and disease outcome

Boursi, Ben; Giantonio, Bruce J.; Haynes, Kevin; Mamtani, Ronac; Yang, Yu‐Xiao

doi:10.1016/j.ejca.2016.02.018

Cited by 24 publications

(18 citation statements)

References 41 publications

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“…These results are in agreement and extend previous reports in cancer patients with T2D, in whom HbA 1c levels were evaluated as a marker of glycemic control[41,42]. In particular, Siddiqui et al[41] reported that poorly controlled T2D - defined as a HbA 1c level ≥ 7.5% - was independently associated with a more advanced CRC stage at time of diagnosis and poorer 5-year survival, thus suggesting that in CRC patients with T2D, poor glycemic control is associated with a clinically aggressive cancer phenotype.…”

Section: Discussionsupporting

confidence: 93%

“…However, the small number of T2D patients enrolled did not confer enough power to perform a separate subgroup analysis. On the other hand, Boursi et al[42] reported no association between HbA 1c levels within 6 mo prior to cancer diagnosis and overall survival for CRC. This study is barely comparable with the results obtained in ours, since it enrolled only T2D patients in whom HbA 1c was evaluated as a marker of glycemic control.…”

Section: Discussionmentioning

confidence: 99%

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Prognostic value of glycated hemoglobin in colorectal cancer

Ferroni¹,

Formica²,

Della-Morte³

et al. 2016

WJG

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AIMTo investigate the clinical significance of routinely used glycemic parameters in a cohort of colorectal cancer (CRC) patients.METHODSPre-treatment fasting blood glucose, insulin, HbA1c and homeostasis model of risk assessment (HOMA-IR) were retrospectively evaluated in a case-control study of 224 CRC and 112 control subjects matched for sex, obesity and diabetes frequency and blood lipid profile. Furthermore, the prognostic value of routinely used glycemic parameters towards progression-free (PFS) and overall survival (OS) was prospectively evaluated.RESULTSFasting blood glucose, insulin, HOMA-IR and HbA1c (all P < 0.0001) levels were higher in non-diabetic CRC patients compared with obesity-matched controls. All parameters were associated with increased CRC risk at ROC analysis, but no relationship with clinical-pathological variables or survival outcomes was observed for glycemia, insulinemia or HOMA-IR. Conversely, advanced CRC stage (P = 0.018) was an independent predictor of increased HbA1c levels, which were also higher in patients who had disease progression compared with those who did not (P = 0.05). Elevated HbA1c levels showed a negative prognostic value both in terms of PFS (HR = 1.24) and OS (HR = 1.36) after adjustment for major confounders, which was further confirmed in a subgroup analysis performed after exclusion of diabetic patients.CONCLUSIONHbA1c might have a negative prognostic value in CRC, thus suggesting that glycemic metabolic markers should be carefully monitored in these patients, independently of overt diabetes.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Prognostic value of glycated hemoglobin in colorectal cancer

Ferroni¹,

Formica²,

Della-Morte³

et al. 2016

WJG

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“…Few studies have explored the relationship between glycemic control and outcomes in cancer patients with or without diabetes. 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.…”

Section: Glycemic Control During Treatmentmentioning

confidence: 99%

“…Two studies found no association between with glycemic control level and outcomes in cancer patients. [ 20 22 ] Boursi et al . used previously obtained HbA1c levels, but patients’ glycemic control level at the time of their cancer diagnosis and while they were undergoing treatment were unknown.…”

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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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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“…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%

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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Serum glucose and hemoglobin A1C levels at cancer diagnosis and disease outcome

Cited by 24 publications

References 41 publications

Prognostic value of glycated hemoglobin in colorectal cancer

Prognostic value of glycated hemoglobin in colorectal cancer

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

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