School of Cancer and Pharmaceutical Sciences, Translational Oncology and Urology Research (TOUR), King's College London, 3rd Floor Bermondsey Wing, Guy's Hospital, London, SE1 9RT, UK.
Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden.
BMC Cancer. 2021 Nov 22;21(1):1259. doi: 10.1186/s12885-021-08941-y.
Gonadotropin Releasing Hormones agonists (GnRH), which are first line treatment for metastatic prostate cancer (PCa), increase risk of type 2 diabetes mellitus (T2DM). This study aims to quantify the association of use of GnRH with diabetes control in PCa men with T2DM.
Nationwide population-based cohort study in the Swedish National Diabetes Register and Prostate Cancer data Base Sweden 4.1, on the association between GnRH and diabetes control in T2DM men with PCa by comparing T2DM men with PCa vs. without PCa, as well as comparing T2DM men with PCa on or not on GnRH. The primary exposure was use of GnRH. Worsening diabetes control was the primary outcome, defined as: 1) HbA1c rose to 58 mmol/mol or higher; 2) HbA1c increase by 10 mmol/mol or more; 3) Start of antidiabetic drugs or switch to insulin. We also combined all above definitions. Cox proportional hazards regression was used to analyze the association.
There were 5714 T2DM men with PCa of whom 692 were on GnRH and 28,445 PCa-free men with T2DM with similar baseline characteristics. Diabetes control was worse in men with GnRH vs. PCa-free men (HR: 1.24, 95% CI: 1.13-1.34) as well as compared with PCa men without GnRH (HR:1.58, 95% CI: 1.39-1.80), when we defined the worsening control of diabetes by combining all definitions above.
Use of GnRH in T2DM men with PCa was associated with worse glycemic control. The findings highlight the need to closely monitor diabetes control in men with T2DM and PCa starting GnRH.
促性腺激素释放激素激动剂（GnRH）是转移性前列腺癌（PCa）的一线治疗药物，但会增加 2 型糖尿病（T2DM）的风险。本研究旨在量化 GnRH 在 T2DM 合并 PCa 男性患者中对糖尿病控制的影响。
在瑞典国家糖尿病登记处和瑞典前列腺癌数据库 4.1 中进行了一项全国性基于人群的队列研究，比较了 T2DM 合并 PCa 男性与无 PCa 的 T2DM 男性，以及 GnRH 治疗与未治疗的 T2DM 合并 PCa 男性之间，使用 GnRH 与糖尿病控制之间的关联。主要暴露因素是 GnRH 的使用。糖尿病控制恶化是主要结局，定义为：1）HbA1c 升高至 58mmol/mol 或更高；2）HbA1c 增加 10mmol/mol 或更多；3）开始使用降糖药物或改用胰岛素。我们还将上述所有定义结合起来进行分析。采用 Cox 比例风险回归分析来评估关联。
共有 5714 例 T2DM 合并 PCa 的男性患者，其中 692 例接受 GnRH 治疗，28445 例无 PCa 的 T2DM 男性患者具有相似的基线特征。与无 PCa 的 T2DM 男性患者相比（HR：1.24，95%CI：1.13-1.34），以及与未接受 GnRH 治疗的 PCa 男性患者相比（HR：1.58，95%CI：1.39-1.80），接受 GnRH 治疗的 T2DM 合并 PCa 男性患者的糖尿病控制更差，当我们将上述所有定义结合起来定义糖尿病控制恶化时，结果更为明显。
在 T2DM 合并 PCa 的男性患者中使用 GnRH 与血糖控制恶化相关。这些发现强调了在开始 GnRH 治疗时，需要密切监测 T2DM 和 PCa 合并男性患者的糖尿病控制。
