Worndl Erin, Fung Kinwah, Fischer Hadas D, Austin Peter C, Krzyzanowska Monika K, Lipscombe Lorraine L
Department of Medicine, University of Toronto, Toronto, ON, Canada.
Institute for Clinical Evaluative Sciences, University of Toronto, Toronto, ON, Canada.
JNCI Cancer Spectr. 2018 Jan;2(1):pky008. doi: 10.1093/jncics/pky008. Epub 2018 May 11.
A cancer diagnosis may disrupt diabetes management, increasing the risk of preventable complications. The objective was to determine whether a cancer diagnosis in patients with diabetes is associated with an increased risk of diabetic complications.
This retrospective cohort study using health care data from Ontario, Canada, included persons age 50 years or older diagnosed with diabetes from 2007 to 2011 and followed until 2014. We examined the effects of cancer as a time-varying covariate: breast cancer (in women), prostate cancer (in men), colorectal cancer, and other cancers (in men and women). Each cancer exposure was categorized as stage I-III, IV, or unknown, and by time since cancer diagnosis (0-1 year, >1-3 years, and >3 years). The primary outcome was hospital visits for diabetic emergencies. Secondary outcomes were hospital visits for skin and soft tissue infections and cardiovascular events.
Of 817 060 patients with diabetes (mean age = 64.9 +/- 10.7 years), there were 9759 (1.2%) colorectal and 45 705 (5.6%) other cancers, 6714 (1.7%) breast cancers among 384 257 women and 10 331 (2.4%) prostate cancers among 432 803 men. For all cancers except stage I-III prostate cancer, rates of diabetic complications were significantly higher zero years to one year after diagnosis compared with no cancer (adjusted relative rates ranging from 1.26, 95% confidence interval [CI] = 1.08 to 1.49, to 4.07, 95% CI = 3.80 to 4.36); these differences were attenuated in the subsequent periods after cancer diagnosis.
Patients with diabetes are at increased risk for preventable complications after a cancer diagnosis. Better diabetes care is needed during this vulnerable period.
癌症诊断可能会扰乱糖尿病管理，增加可预防并发症的风险。目的是确定糖尿病患者的癌症诊断是否与糖尿病并发症风险增加相关。
这项回顾性队列研究使用了来自加拿大安大略省的医疗保健数据，纳入了2007年至2011年诊断为糖尿病且年龄在50岁及以上并随访至2014年的人群。我们将癌症作为一个随时间变化的协变量进行研究：乳腺癌（女性）、前列腺癌（男性）、结直肠癌和其他癌症（男性和女性）。每种癌症暴露情况分为I - III期、IV期或未知，并按癌症诊断后的时间（0 - 1年、>1 - 3年和>3年）进行分类。主要结局是糖尿病急症的住院就诊。次要结局是皮肤和软组织感染及心血管事件的住院就诊。
在817060例糖尿病患者（平均年龄 = 64.9±10.7岁）中，有9759例（1.2%）患结直肠癌，45705例（5.6%）患其他癌症，384257名女性中有6714例（1.7%）患乳腺癌，432803名男性中有10331例（2.4%）患前列腺癌。除I - III期前列腺癌外，所有癌症在诊断后0至1年的糖尿病并发症发生率均显著高于无癌症者（调整后的相对率范围为1.26，95%置信区间[CI] = 1.08至1.49，至4.07，95% CI = 3.80至4.36）；这些差异在癌症诊断后的后续时期有所减弱。
糖尿病患者在癌症诊断后发生可预防并发症的风险增加。在此脆弱时期需要更好的糖尿病护理。
