Division of Urology, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
Cardio-oncology Research Unit, Cardiovascular Analytics Group, China-UK Collaboration, Hong Kong, China.
Cancer Med. 2023 Apr;12(8):9128-9132. doi: 10.1002/cam4.5651. Epub 2023 Feb 3.
Androgen deprivation therapy (ADT), used increasingly in the treatment of prostate cancer (PCa), negatively influences glycemic control in diabetes and is associated with an increased risk of diabetes complications where hospitalization commonly ensues. Metformin could decrease the metabolic consequences of ADT and enhance its effect. This study examined the association of metformin use with healthcare resources utilization among diabetic, PCa patients receiving ADT.
Diabetic adults with PCa on ADT in Hong Kong between December 1999 and March 2021 were identified. Patients with <6 months of concurrent metformin and ADT use were excluded. All included patients were followed up until September 2021. The outcomes were hospital attendances and related costs.
In total, 1,284 metformin users and 687 non-users were studied. Over 8,045 person-years, 9,049 accident and emergency (A&E), and 21,262 inpatient attendances, with 11,2781 days of hospitalization were observed. Metformin users had significantly fewer A&E attendances (incidence rate ratio (IRR): 0.61 [95% confidence interval 0.54-0.69], p < 0.001), inpatient attendances (IRR: 0.57 [0.48-0.67], p < 0.001), and days of hospitalization (IRR: 0.55 [0.42-0.72], p < 0.001). Annual attendance costs were lower for metformin users than non-users (cost ratio: 0.28 [0.10-0.80], p = 0.017).
Metformin use was associated with decreased hospital attendances, days of hospitalization, and associated costs, which could help reduce healthcare resource utilization following ADT in the treatment of PCa.
雄激素剥夺疗法（ADT）在前列腺癌（PCa）治疗中的应用日益增加，会对糖尿病患者的血糖控制产生负面影响，并增加糖尿病并发症的风险，进而导致住院治疗。二甲双胍可能会降低 ADT 的代谢后果，并增强其疗效。本研究旨在探讨二甲双胍的使用与接受 ADT 的糖尿病 PCa 患者医疗资源利用之间的关系。
在香港，我们确定了 1999 年 12 月至 2021 年 3 月期间接受 ADT 的糖尿病合并 PCa 的成年患者。排除了同时使用二甲双胍和 ADT 不足 6 个月的患者。所有纳入的患者均随访至 2021 年 9 月。结局指标是住院就诊次数和相关费用。
共纳入了 1284 名二甲双胍使用者和 687 名非使用者。在 8045 人年的随访中，共观察到 9049 次急诊就诊和 21262 次住院就诊，其中 112781 天需要住院治疗。与非使用者相比，二甲双胍使用者的急诊就诊次数（发生率比（IRR）：0.61[95%置信区间 0.54-0.69]，p<0.001）、住院就诊次数（IRR：0.57[0.48-0.67]，p<0.001）和住院天数（IRR：0.55[0.42-0.72]，p<0.001）均显著减少。与非使用者相比，二甲双胍使用者的年就诊费用也更低（成本比：0.28[0.10-0.80]，p=0.017）。
二甲双胍的使用与 ADT 治疗 PCa 后减少就诊次数、住院天数和相关费用有关，这可能有助于降低医疗资源的利用。
