Mazzilli Rossella, Zamponi Virginia, Mancini Camilla, Giorgini Beatrice, Golisano Bianca, Mikovic Nevena, Pecora Giulia, Russo Flaminia, Martiradonna Maurizio, Paravani Piero, Prosperi Daniela, Faggiano Antongiulio
Unit of Endocrinology, Department of Clinical and Molecular Medicine, ENETS Center of Excellence, Sapienza University of Rome, Rome, Italy.
Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy.
Endocrine. 2025 Apr;88(1):36-50. doi: 10.1007/s12020-024-04149-9. Epub 2025 Jan 3.
Diabetes mellitus (DM) and neuroendocrine tumors (NET) can exert unfavorable effects on each other prognosis. In this narrative review, we evaluated the effects of NET therapies on glycemic control and DM management and the effects of anti-diabetic therapies on NET outcome and management. For this purpose, we searched the PubMed, Science Direct, and Google Scholar databases for studies reporting the effects of NET therapy on DM as well as the effect of DM therapy on NET. The majority of NET treatments appear to impair glycaemic control, both inducing hypoglycemic or, more commonly, hyperglycemia and even new-onset DM. However, glucose metabolism imbalance can be effectively managed by modulating anti-diabetic therapy and adopting an appropriate nutritional approach. On the other hand, the effects of anti-diabetic treatment, like insulin, sulfonylureas, thiazolidinediones, ipeptidyl-peptidase-4 inhibitors, Glucagon-like peptide-1 receptor agonists, and Sodium-glucose cotransporter-2 inhibitors on NET are unclear. Recently, metformin has been investigated in patients with gastroenteropancreatic NET resulting in improved progression free survival suggesting a potential antineoplastic role. Finally, the management of DM in patients with NET is of great clinical relevance to correctly perform radiological procedures and even more functional imaging procedures, as well as to optimize the therapy and avoid treatment withdrawal or discontinuation. In conclusion, understanding the mechanisms underlying therapy-induced DM and implementing appropriate monitoring and management strategies of DM are essential for optimizing NET patient outcome and quality of life.
糖尿病（DM）与神经内分泌肿瘤（NET）会对彼此的预后产生不利影响。在这篇叙述性综述中，我们评估了NET治疗对血糖控制和DM管理的影响，以及抗糖尿病治疗对NET结局和管理的影响。为此，我们在PubMed、Science Direct和谷歌学术数据库中搜索了报告NET治疗对DM的影响以及DM治疗对NET的影响的研究。大多数NET治疗似乎都会损害血糖控制，既会诱发低血糖，或者更常见的是，诱发高血糖甚至新发DM。然而，通过调整抗糖尿病治疗和采取适当的营养方法，可以有效管理葡萄糖代谢失衡。另一方面，抗糖尿病治疗，如胰岛素、磺脲类药物、噻唑烷二酮类药物、二肽基肽酶-4抑制剂、胰高血糖素样肽-1受体激动剂和钠-葡萄糖协同转运蛋白-2抑制剂对NET的影响尚不清楚。最近，已对胃肠胰NET患者使用二甲双胍进行研究，结果显示无进展生存期得到改善，提示其具有潜在的抗肿瘤作用。最后，NET患者的DM管理对于正确进行放射学检查，甚至更重要的是功能成像检查，以及优化治疗并避免治疗中断或停药具有重要的临床意义。总之，了解治疗诱发DM的机制并实施适当的DM监测和管理策略对于优化NET患者的结局和生活质量至关重要。
