Division of Medical Oncology, National Cancer Center Hospital, Tokyo, Japan.
J Palliat Med. 2013 Jul;16(7):790-3. doi: 10.1089/jpm.2012.0471. Epub 2013 Feb 28.
No method is available for evidence-based glycemic-control management in the context of advanced cancer.
This study aimed to analyze, by investigating A1C levels, the necessity of glycemic control in terminal cancer patients with preexisting type 2 diabetes.
This was a retrospective study.
We analyzed 53 terminal cancer patients who had preexisting type 2 diabetes. All patients first visited Kondo Hospital between April 2002 and December 2006.
We assessed the necessity of glycemic control based on the length of hospitalization and the length of the end-of-life period by using the Kaplan-Meier method and Cox hazard model. Length of the end-of-life period was calculated from the completion of palliative chemotherapy until death. Length of hospitalization was calculated from last admission until death.
The median length of hospitalization was significantly longer in relatively well controlled patients--with A1C levels <7.5% (49 days; 95% confidence interval [CI] 34.9-63.1)--than in poorly controlled patients, with A1C levels ≥7.5% (23 days; 95% CI 14.6-31.4, P=0.05). The median length of end of life was significantly longer in the relatively well controlled patients (144 days; 95% CI 115.9-172.1) than in poorly controlled patients (45 days; 95% CI 13.8-76.2, P=0.02). Cox multivariate analysis indicated that performance status (PS) at the initial visit to the hospice (hazard ratio [HR] 2.79; 95% CI 1.46-5.32, P=0.002) and glycemic control (HR 2.10; 95% CI 1.18-3.75, P=0.01) were independent, positive prognostic factors.
Good glycemic control, that is, maintenance of A1C levels at <7.5% during the terminal phase of cancer, conferred a significant survival benefit in cancer patients who had preexisting type 2 diabetes.
目前尚无针对晚期癌症患者的循证血糖控制管理方法。
本研究旨在通过检测糖化血红蛋白（A1C）水平，分析患有 2 型糖尿病的终末期癌症患者血糖控制的必要性。
这是一项回顾性研究。
我们分析了 53 例患有 2 型糖尿病的终末期癌症患者。所有患者均于 2002 年 4 月至 2006 年 12 月首次在近藤医院就诊。
我们使用 Kaplan-Meier 法和 Cox 风险模型根据住院时间和临终期长短评估血糖控制的必要性。临终期的长短从姑息性化疗结束到死亡计算。住院时间从最后一次入院到死亡计算。
A1C 水平＜7.5%（49 天；95%置信区间 [CI] 34.9-63.1）的患者的中位住院时间明显长于 A1C 水平≥7.5%（23 天；95%CI 14.6-31.4，P=0.05）的患者。A1C 水平相对较好控制（144 天；95%CI 115.9-172.1）的患者中位临终期明显长于 A1C 水平控制不佳（45 天；95%CI 13.8-76.2，P=0.02）的患者。Cox 多变量分析表明，临终关怀初始就诊时的表现状态（PS）（危险比 [HR] 2.79；95%CI 1.46-5.32，P=0.002）和血糖控制（HR 2.10；95%CI 1.18-3.75，P=0.01）是独立的阳性预后因素。
在癌症的终末期，良好的血糖控制，即 A1C 水平维持在＜7.5%，可为患有 2 型糖尿病的癌症患者带来显著的生存获益。
