AACE ePoster Library

THE IMPACT OF DIABETES MELLITUS AND FASTING GLUCOSE LEVELS ON CLINICAL OUTCOMES IN COLORECTAL CANCER.
AACE ePoster Library. Duma N. 05/13/15; 97799; 207
Dr. Narjust Duma
Dr. Narjust Duma
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Abstract
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Background: There is evidence of an emerging etiologic link between diabetes mellitus (DM) and several gastrointestinal malignancies. However, the mechanisms underlying the correlation are still under investigation. The role of insulin and the insulin-like growth factor-I have been implicated in carcinogenesis and tumor growth via their regulation of cell growth and proliferation. The aim of this study was to investigate the influence of DM and glucose levels on clinical outcomes and treatment of patients with colorectal cancer (CRC).

Methods: We conducted a retrospective review of all patients diagnosed with CRC at our institution between 2011 and 2013. Demographics, tumor characteristics, DM diagnosis data and fasting glucose levels at diagnosis and before chemotherapy were abstracted. Pearson chi-square test was used to compare variables. Kaplan-Meier and Cox regression were used for survival and multivariate analysis.

Results: We identified 376 patients, among whom 28% (104) had DM. The CRC patients with diabetes were older with a mean age of 69 years vs. 65 years of patients without DM, but had similar tumor characteristics including stage and grade. Adenocarcinoma was the most common histologic subtype representing 87% of all cases. The mean HbA1C among diabetic patients was 6.7 (range 5.6-12.2). The average fasting glucose at diagnosis was 156 (79-399) and before chemotherapy it was 134 (56-340). Diabetic patients were less likely to receive adjuvant chemotherapy or second surgical interventions (51% vs. 65%, p<0.04 and 9% vs. 24%, p<0.004, respectively). Patients with DM had shorter overall median survival when compared to patients without DM, 17.4 months (95%CI: 14.7-20.1) vs. 27 months (95%CI: 25.1-28.2) (p<0.03). After adjusting for several comorbidities including obesity, DM was an independent and significant predictor of survival (OR: 1.41, p<0.02). Fasting glucose levels were not predictors of survival by univariate or univariate analysis.

Discussion: Our CRC patients with DM had a decreased overall survival of approximately 10 months compared to those without DM. Despite having similar tumor characteristics, diabetic patients were less likely to receive adjuvant chemotherapy or second surgical interventions, which could be partially explained by the lack of comorbidities and a younger age in the non-diabetic patients.

Conclusion: Our findings represent a clear example of the role of comorbidities in the treatment of cancer patients. Patients should be seen in a holistic manner where each co-morbidity can affect outcomes. Further investigation is needed, as this could potentially change the way we treat cancer patients with DM.
Background: There is evidence of an emerging etiologic link between diabetes mellitus (DM) and several gastrointestinal malignancies. However, the mechanisms underlying the correlation are still under investigation. The role of insulin and the insulin-like growth factor-I have been implicated in carcinogenesis and tumor growth via their regulation of cell growth and proliferation. The aim of this study was to investigate the influence of DM and glucose levels on clinical outcomes and treatment of patients with colorectal cancer (CRC).

Methods: We conducted a retrospective review of all patients diagnosed with CRC at our institution between 2011 and 2013. Demographics, tumor characteristics, DM diagnosis data and fasting glucose levels at diagnosis and before chemotherapy were abstracted. Pearson chi-square test was used to compare variables. Kaplan-Meier and Cox regression were used for survival and multivariate analysis.

Results: We identified 376 patients, among whom 28% (104) had DM. The CRC patients with diabetes were older with a mean age of 69 years vs. 65 years of patients without DM, but had similar tumor characteristics including stage and grade. Adenocarcinoma was the most common histologic subtype representing 87% of all cases. The mean HbA1C among diabetic patients was 6.7 (range 5.6-12.2). The average fasting glucose at diagnosis was 156 (79-399) and before chemotherapy it was 134 (56-340). Diabetic patients were less likely to receive adjuvant chemotherapy or second surgical interventions (51% vs. 65%, p<0.04 and 9% vs. 24%, p<0.004, respectively). Patients with DM had shorter overall median survival when compared to patients without DM, 17.4 months (95%CI: 14.7-20.1) vs. 27 months (95%CI: 25.1-28.2) (p<0.03). After adjusting for several comorbidities including obesity, DM was an independent and significant predictor of survival (OR: 1.41, p<0.02). Fasting glucose levels were not predictors of survival by univariate or univariate analysis.

Discussion: Our CRC patients with DM had a decreased overall survival of approximately 10 months compared to those without DM. Despite having similar tumor characteristics, diabetic patients were less likely to receive adjuvant chemotherapy or second surgical interventions, which could be partially explained by the lack of comorbidities and a younger age in the non-diabetic patients.

Conclusion: Our findings represent a clear example of the role of comorbidities in the treatment of cancer patients. Patients should be seen in a holistic manner where each co-morbidity can affect outcomes. Further investigation is needed, as this could potentially change the way we treat cancer patients with DM.

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