Zanders Marjolein M J, van Herk-Sukel Myrthe P P, Herings Ron M C, van de Poll-Franse Lonneke V, Haak Harm R
Netherlands Comprehensive Cancer Organisation, P.O. Box 231, 5600 AE, Eindhoven, The Netherlands.
Department of Internal Medicine, Máxima Medical Centre, Eindhoven, Veldhoven, The Netherlands.
Acta Diabetol. 2016 Oct;53(5):727-35. doi: 10.1007/s00592-016-0863-z. Epub 2016 Apr 18.
This study aims to evaluate the impact of cancer and its treatment on HbA1c values among individuals with colorectal cancer (CRC) using glucose-lowering drugs (GLDs).
Patients with primary CRC (1998-2011) were selected from the Eindhoven Cancer Registry and linked to the PHARMO Database Network including outpatient pharmacy and clinical laboratory data. Patients with more than 2 years of GLDs use prior to cancer diagnosis were included. Linear mixed-effects models were conducted to evaluate changes in HbA1c for colon cancer (CC) and rectal cancer (RC) patients in the 4 years around CRC diagnosis.
Of all CRC patients (n = 4714), 294 (6 %) GLDs users with CC and 144 (3 %) with RC were selected. In the crude model, mean HbA1c at cancer diagnosis was 6.9 % (51.6 mmol/mol) among CC patients and 7.1 % (53.5 mmol/mol) among RC patients. Among CC patients, HbA1c decreased with 0.12 % per year (p = 0.0002) before cancer diagnosis in the adjusted model, and after diagnosis, it increased with 0.12 % per year (p = 0.02). In subgroup analyses, effects on HbA1c were more pronounced in users of anti-anaemic preparations. Among RC patients, HbA1c decreased before diagnosis with 0.18 % per year (p = 0.0006), whereas after diagnosis it changed non-significantly.
Among users of GLDs, HbA1c decreased with 0.12-0.18 % (1-2 mmol/mol) per year before CRC diagnosis. Only among CC patients, HbA1c increased after diagnosis (0.12 % per year; 1.3 mmol/mol). Modest changes in HbA1c before CRC diagnosis may reflect the effects of an undiagnosed cancer, such as weight loss, anaemia, or the use of anti-anaemic preparations.
本研究旨在评估癌症及其治疗对使用降糖药物（GLDs）的结直肠癌（CRC）患者糖化血红蛋白（HbA1c）值的影响。
从埃因霍温癌症登记处选取2008 - 2011年原发性CRC患者，并与包含门诊药房和临床实验室数据的PHARMO数据库网络进行关联。纳入癌症诊断前使用GLDs超过2年的患者。采用线性混合效应模型评估CRC诊断前后4年结肠癌（CC）和直肠癌（RC）患者HbA1c的变化。
在所有CRC患者（n = 4714）中，选取了294例（6%）使用GLDs的CC患者和144例（3%）使用GLDs的RC患者。在粗略模型中，CC患者癌症诊断时的平均HbA1c为6.9%（51.6 mmol/mol），RC患者为7.1%（53.5 mmol/mol）。在CC患者中，调整模型显示癌症诊断前HbA1c每年下降0.12%（p = 0.0002），诊断后每年上升0.12%（p = 0.02）。亚组分析中，抗贫血制剂使用者对HbA1c的影响更显著。在RC患者中，诊断前HbA1c每年下降0.18%（p = 0.0006），而诊断后变化不显著。
在GLDs使用者中，CRC诊断前HbA1c每年下降0.12 - 0.18%（1 - 2 mmol/mol）。仅CC患者诊断后HbA1c上升（每年0.12%；1.3 mmol/mol）。CRC诊断前HbA1c的适度变化可能反映了未确诊癌症的影响，如体重减轻、贫血或抗贫血制剂的使用。
