Glycaemic control in people with type 2 diabetes mellitus during and after cancer treatment: A systematic review and meta-analysis

Abstract

Background: Cancer and Diabetes Mellitus (DM) are leading causes of death worldwide and the prevalence of both is escalating. People with co-morbid cancer and DM have increased morbidity and premature mortality compared with cancer patients with no DM. The reasons for this are likely to be multifaceted but will include the impact of hypo/hyperglycaemia and diabetes therapies on cancer treatment and disease progression. A useful step toward addressing this disparity in treatment outcomes is to establish the impact of cancer treatment on diabetes control.

Aim: The aim of this review is to identify and analyse current evidence reporting glycaemic control (HbA1c) during and after cancer treatment.

Methods: Systematic searches of published quantitative research relating to comorbid cancer and type 2 diabetes mellitus were conducted using databases, including Medline, Embase, PsychINFO, CINAHL and Web of Science (February 2017). Full text publications were eligible for inclusion if they: were quantitative, published in English language, investigated the effects of cancer treatment on glycaemic control, reported HbA1c (%/mmols/mol) and included adult populations with diabetes. Means, standard deviations and sample sizes were extracted from each paper; missing standard deviations were imputed. The completed datasets were analysed using a random effects model. A mixed-effects analysis was undertaken to calculate mean HbA1c (%/mmols/mol) change over three time periods compared to baseline.

Results: The available literature exploring glycaemic control post-diagnosis was mixed. There was increased risk of poor glycaemic control during this time if studies of surgical treatment for gastric cancer are excluded, with significant differences between baseline and 12 months (p < 0.001) and baseline and 24 months (p = 0.002).

Conclusion: We found some evidence to support the contention that glycaemic control during and/or after non-surgical cancer treatment is worsened, and the reasons are not well defined in individual studies. Future studies should consider the reasons why this is the case.

Fig 1. Data retrieval and assessment.

Fig 2. Forest plot of studies considering mean HbA1c levels (%) at time of cancer diagnosis and treatment initiation.

Fig 3. Forest plot of studies considering mean HbA1c levels (%) at 12 months post time of cancer diagnosis and treatment initiation.

Fig 4. Forest plot of studies considering mean HbA1c levels (%) at 24 months post time of cancer diagnosis and treatment initiation.

Fig 5. Forest plot of collapsed studies considering HbA1c levels at baseline and two-year estimates.