Gallo Marco, Muscogiuri Giovanna, Felicetti Francesco, Faggiano Antongiulio, Trimarchi Francesco, Arvat Emanuela, Vigneri Riccardo, Colao Annamaria
Oncological Endocrinology Unit, Department of Medical Sciences, University of Turin, AOU Città della Salute e della Scienza di Torino, Turin, Italy.
Ios and Coleman Medicina Futura Medical Centre, Naples, Italy.
Metabolism. 2018 Jan;78:141-154. doi: 10.1016/j.metabol.2017.09.013. Epub 2017 Oct 7.
Diabetes and cancer are common, chronic, and potentially fatal diseases that frequently co-exist. Observational studies have reported an increased risk of cancer in patients with diabetes. Furthermore, many patients with cancer already have diabetes, or develop hyperglycaemia as a consequence of the tumor or of cancer therapies, and coexisting diabetes confers a greater risk of mortality for many malignancies. Managing oncologic patients with diabetes is often complicated, since the co-existence of diabetes and cancer poses several complex clinical questions: what level of glycaemic control to achieve, which therapy to use, how to deal with glucocorticoid therapies and artificial nutrition, how diabetes complications can affect cancer management, which drug-drug interactions should be taken into account, or even how to manage diabetes at the end of life. In the clinical setting, both at hospital and at home, there are little agreed, evidence-based guidelines on the best management and criteria upon which clinical decisions should be based. A practical solution lies in the implementation of care networks based on communication and ongoing collaboration between Oncologists, Endocrinologists, and the nursing staff, with the patient at the centre of the care process. This manuscript aims to review the current evidence on the effect of cancer therapies on glucose metabolism and to address some of the more common challenges of diabetes treatment in patients with cancer.
糖尿病和癌症是常见的慢性且可能致命的疾病，二者常并存。观察性研究报告称糖尿病患者患癌风险增加。此外，许多癌症患者已患有糖尿病，或因肿瘤或癌症治疗而出现高血糖，并存的糖尿病会使许多恶性肿瘤的死亡风险更高。管理患有糖尿病的肿瘤患者往往很复杂，因为糖尿病和癌症并存带来了几个复杂的临床问题：要达到何种血糖控制水平、使用何种治疗方法、如何应对糖皮质激素治疗和人工营养、糖尿病并发症如何影响癌症治疗、应考虑哪些药物相互作用，甚至在生命末期如何管理糖尿病。在临床环境中，无论是在医院还是在家中，关于最佳管理以及临床决策应依据的标准，几乎没有达成共识的循证指南。一个切实可行的解决办法是建立基于肿瘤学家、内分泌学家和护理人员之间沟通与持续协作的照护网络，将患者置于照护过程的中心。本文旨在综述当前关于癌症治疗对葡萄糖代谢影响的证据，并解决癌症患者糖尿病治疗中一些更常见的挑战。
