Derweesh Ithaar H, Diblasio Christopher J, Kincade Matt C, Malcolm John B, Lamar Kimberly D, Patterson Anthony L, Kitabchi Abbas E, Wake Robert W
Department of Urology, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
BJU Int. 2007 Nov;100(5):1060-5. doi: 10.1111/j.1464-410X.2007.07184.x. Epub 2007 Sep 14.
OBJECTIVE To investigate the incidence of new-onset diabetes mellitus (NODM) and of worsening glycaemic control in established DM after starting androgen-deprivation therapy (ADT) for prostate cancer, as ADT is associated with altered body composition, potentially influencing insulin sensitivity. PATIENTS AND METHODS We retrospectively reviewed patients receiving ADT for prostate cancer at our institution between January 1989 and July 2005; those with incomplete information and those receiving only neoadjuvant ADT were excluded. Variables examined included age, race, body mass index (BMI), pretreatment prostate-specific antigen, Gleason sum, clinical stage, ADT type (medical vs surgical) and schedule (continuous vs intermittent), presence of pre-existing DM, serum glucose and glycosylated haemoglobin (HbA1c) levels before and after ADT, and receipt of vitamin D or bisphosphonate supplementation. Data were analysed statistically and P < 0.05 considered to indicate significance. RESULTS In all, 396 patients (median age 73.2 years; median BMI of 26.7 kg/m(2) at ADT initiation) were analysed. Of these, 59.1% were African-American and 40.9% were Caucasian/other. At a median follow-up of 60.1 months, 36 (11.3%) patients developed NODM. In 77 patients with pre-existing DM, there was an increase of >/=10% in serum HbA1c or fasting glucose levels in 15 (19.5%) and 22 (28.6%), respectively. On multivariate analysis, a BMI of >/=30 kg/m(2) was associated with an increased risk of developing NODM (odds ratio 4.65, P = 0.031). Receipt of vitamin D had a protective effect (odds ratio 5.75, P = 0.017). CONCLUSIONS Patients receiving ADT for prostate cancer with or with no history of DM should have routine surveillance of glycaemic control, particularly when their BMI is >/= 30 kg/m(2), with appropriate preventive and treatment measures.
目的 探讨前列腺癌患者开始雄激素剥夺治疗（ADT）后新发糖尿病（NODM）的发生率以及已患糖尿病患者血糖控制恶化的情况，因为ADT与身体成分改变有关，可能会影响胰岛素敏感性。患者与方法 我们回顾性分析了1989年1月至2005年7月在我院接受ADT治疗的前列腺癌患者；排除信息不完整的患者以及仅接受新辅助ADT的患者。检查的变量包括年龄、种族、体重指数（BMI）、治疗前前列腺特异性抗原、Gleason评分、临床分期、ADT类型（药物治疗与手术治疗）和方案（持续治疗与间歇治疗）、既往是否患糖尿病、ADT前后的血清葡萄糖和糖化血红蛋白（HbA1c）水平，以及是否接受维生素D或双膦酸盐补充治疗。对数据进行统计学分析，P<0.05认为具有统计学意义。结果 共分析了396例患者（中位年龄73.2岁；ADT开始时中位BMI为26.7kg/m²）。其中，59.1%为非裔美国人，40.9%为白种人/其他种族。中位随访60.1个月时，36例（11.3%）患者发生NODM。在77例既往患糖尿病的患者中，分别有15例（19.5%）和22例（28.6%）的血清HbA1c或空腹血糖水平升高≥10%。多因素分析显示，BMI≥30kg/m²与发生NODM的风险增加相关（比值比4.65，P=0.031）。接受维生素D治疗具有保护作用（比值比5.75，P=0.017）。结论 接受ADT治疗的前列腺癌患者，无论有无糖尿病史，都应常规监测血糖控制情况，尤其是当BMI≥30kg/m²时，应采取适当的预防和治疗措施。
