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接受化疗的乳腺癌和结直肠癌患者新发糖尿病的发病率和疾病进程：一项前瞻性多中心队列研究。

Incidence and disease course of new-onset diabetes mellitus in breast and colorectal cancer patients undergoing chemotherapy: A prospective multicenter cohort study.

机构信息

Department of Internal Medicine, National Cancer Center, Goyang, Republic of Korea; Center for Thyroid Cancer, National Cancer Center, Goyang, Republic of Korea.

Division of Endocrinology, Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Republic of Korea; Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.

出版信息

Diabetes Res Clin Pract. 2021 Apr;174:108751. doi: 10.1016/j.diabres.2021.108751. Epub 2021 Mar 17.

DOI:10.1016/j.diabres.2021.108751

PMID:33722701

Abstract

AIMS

To investigate the incidence of and risk factors for new-onset type 2 diabetes mellitus (DM) developed during chemotherapy that included steroids in cancer patients without DM.

METHODS

This multicenter, prospective, and observational cohort study enrolled 299 cancer patients without DM (aged > 18 years), planning 4-8 cycles of adjuvant chemotherapy. The endpoints were the incidence, remission rate, and independent determinants of new-onset DM during chemotherapy.

RESULTS

Between April 2015 and March 2018, 270 subjects with colorectal cancer or breast cancer (mean age, 51.0 years) completed the follow up (mean 39 months). Of whom, 17 subjects (6.3%) developed DM within a median time of 90 days (range, 17-359 days). Male sex (hazard ratio [HR], 15.839; 95% confidence interval [CI], 2.004-125.20) and impaired fasting glucose (IFG) at baseline (HR, 8.307; CI, 1.826-37.786) were independent risk factors. Six months after chemotherapy completion, 11/17 subjects (64.7%) experienced DM remission, associated with a significantly higher C-peptide level at baseline (C-peptide levels, 1.3 ng/mL in subjects with remission and 0.9 ng/mL in subjects without remission, age- and sex-adjusted P = 0.007).

CONCLUSIONS

DM incidence was 6.3% in patients who received chemotherapy with dexamethasone. Close monitoring for hyperglycemia is recommended, especially for men with IFG.

TRIAL REGISTRATION

ClinicalTrials.gov (NCT03062072).

摘要

目的

研究无糖尿病癌症患者在接受含类固醇化疗期间新发 2 型糖尿病（DM）的发生率和危险因素。

方法

本多中心、前瞻性、观察性队列研究纳入了 299 例无 DM（年龄＞18 岁）的癌症患者，计划接受 4-8 个周期的辅助化疗。终点是化疗期间新发 DM 的发生率、缓解率和独立决定因素。

结果

2015 年 4 月至 2018 年 3 月，270 例结直肠癌或乳腺癌患者（平均年龄 51.0 岁）完成了随访（平均 39 个月）。其中，17 例（6.3%）在中位时间 90 天（范围 17-359 天）内发生 DM。男性（危险比 [HR]，15.839；95%置信区间 [CI]，2.004-125.20）和基线时空腹血糖受损（IFG）（HR，8.307；CI，1.826-37.786）是独立的危险因素。化疗结束后 6 个月，17 例患者中有 11 例（64.7%）DM 缓解，与基线时 C 肽水平显著升高相关（缓解组 C 肽水平为 1.3ng/mL，未缓解组为 0.9ng/mL，年龄和性别调整后 P=0.007）。