Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Vanderbilt-Ingram Cancer Center, Nashville, Tennessee, USA.
J Adolesc Young Adult Oncol. 2021 Apr;10(2):217-225. doi: 10.1089/jayao.2020.0071. Epub 2020 Jul 29.
Rates of obesity and obesity-related health consequences, including type 2 diabetes (T2D) and cancer, continue to rise. While cancer patients are at an increased risk of developing T2D, the prevalence of T2D and insulin prescription among young patients with cancer remains unknown. Using the Total Cancer Care Study cohort at Huntsman Cancer Institute (Salt Lake City, UT), we identified individuals age 18-39 years at cancer diagnosis between 2009 and 2019. Multivariable logistic regression was used to investigate associations between body mass index (BMI) with insulin prescription within 1 year of cancer diagnosis. In total, 344 adolescents and young adults (AYAs) were diagnosed with primary invasive cancer. Within this cohort, 19 patients (5.5%) were ever diagnosed with T2D, 48 AYAs ever received an insulin prescription (14.0%), and 197 were overweight or obese (BMI: 25+ kg/m) at cancer diagnosis. Each kg/m unit increase in BMI was associated with 6% increased odds of first insulin prescription within 1 year of cancer diagnosis among AYAs, even after adjustment for age, sex, smoking history, marital status, glucocorticoid prescription, and cancer treatments (odds ratio = 1.06, 95% confidence interval 1.02-1.11; = 0.005). One in every 18 AYAs with cancer ever had T2D, 1 in 7 AYA patients with cancer ever received an insulin prescription, and higher BMI was associated with increased risk of insulin prescription within a year of cancer diagnosis among AYAs. Understanding the incidence of T2D and insulin prescription/use is critical for short-term and long-term clinical management of AYAs with cancer.
肥胖率和与肥胖相关的健康后果（包括 2 型糖尿病[T2D]和癌症）持续上升。虽然癌症患者发生 T2D 的风险增加，但年轻癌症患者中 T2D 的患病率和胰岛素处方的使用情况尚不清楚。 我们利用 Huntsman 癌症研究所（盐湖城，犹他州）的全癌症护理研究队列，确定了 2009 年至 2019 年期间诊断为癌症时年龄在 18-39 岁的个体。多变量逻辑回归用于研究癌症诊断后 1 年内 BMI 与胰岛素处方之间的关联。 共有 344 名青少年和年轻人（AYA）被诊断出患有原发性浸润性癌症。在该队列中，19 名患者（5.5%）被诊断出患有 T2D，48 名 AYA 患者曾接受过胰岛素处方（14.0%），197 名患者在癌症诊断时超重或肥胖（BMI：25+kg/m）。BMI 每增加 1kg/m，AYA 在癌症诊断后 1 年内首次使用胰岛素的几率增加 6%，即使在调整了年龄、性别、吸烟史、婚姻状况、皮质类固醇处方和癌症治疗后也是如此（比值比=1.06，95%置信区间 1.02-1.11；=0.005）。每 18 名患有癌症的 AYA 中就有 1 名患有 T2D，每 7 名患有癌症的 AYA 中就有 1 名接受过胰岛素处方，BMI 较高与 AYA 癌症诊断后一年内使用胰岛素的风险增加相关。了解 T2D 和胰岛素处方/使用的发生率对于青少年和年轻人癌症患者的短期和长期临床管理至关重要。
