Androgen-deprivation Therapy and Diabetes Control Among Diabetic Men with Prostate Cancer

Abstract

Background Androgen deprivation therapy (ADT) for prostate cancer is associated with decreased insulin sensitivity and incident diabetes. Few data are available about the effects of ADT on diabetes control among men with diabetes. We examined care for over 7500 men with prostate cancer who had diabetes at the time of diagnosis to assess the effect of ADT on diabetes control, as measured by HbA1c levels and the intensification of diabetes drug therapy. Methods We compared hemoglobin A1c (HbA1c) levels and intensification of diabetes pharmacotherapy among 2237 pairs of propensity matched men with prostate cancer and diabetes who were or were not treated with ADT. We calculated the difference-in-difference of HbA1c levels at baseline and 1 and 2 years in the 2 groups, compared using a paired t test. We used a Cox proportional hazards model to estimate time to intensification of diabetes therapy. Results The mean (SE) HbA1c at baseline was 7.24 (0.05) for the ADT group and 7.24 (0.04) for the no-ADT group. HbA1c increased at 1 year for men treated with ADT to 7.38 (0.04) and decreased among men not treated with ADT to 7.14 (0.04), for a difference in differences of +0.24 (P=0.008). Results were similar at 2 years (P=.03). Receipt of ADT was also associated with an increased hazard of addition of diabetes medication (adjusted hazard ratio=1.20, 95% CI=1.09-1.32). Conclusions ADT is associated with worsening of diabetes control, with both increases in HbA1c levels and the need for additional diabetes medications.

Hypogonadism alters cecal and fecal microbiota in male mice

“…A meta-analysis showed that higher testosterone levels are associated with lower and higher T2DM risks in men and women, respectively 37 . In addition, androgen deprivation therapy for prostate cancer patients leads to a worsening of T2DM 38 . In our recent study with HFD-fed mice, fasting glucose levels increased after castration, whereas castration did not affect insulin resistance 16 .…”

Androgen Deprivation Therapy (ADT), Metabolic Syndrome and Metastatic Prostate Cancer: In Vivo and In Vitro Assessments of Effects of Metformin

“…Consistent with previously published data, ADT and subsequent hypogonadism resulted in an increase in serum measurements such as total cholesterol level (p=0.01), fasting insulin (p=0.006), and HOMA levels (0.008) by visit 3 without significant physical changes [69,203]. This is a well-recognized phenomenon and long-term implications include increased risk of diabetes, cardiovascular and cerebrovascular disease [141,[225][226][227]. In recognition of previous publications correlating ADT with adverse health effects, a science advisory statement was made from the American Heart Association (supported by Food and Drugs Administration) stating, "It is reasonable, on the basis of the above data, to state that there may be a relation between ADT and cardiovascular events and death" [141].…”

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

“…Adherence and changes to diabetes medication were reported in three studies [31,34], as well as information on diabetes-related complications assessed by occurrence of neuropathy, nephropathy and retinopathy [36]. …”

“…Two studies reported an increase in HbA1c after androgen deprivation therapy (ADT) was initiated [33,34] and one study described raised HbA1c levels following diagnosis and treatment (not specified) for breast cancer [31]. One study in gastric cancer showed mixed results according to type of surgical procedure and/or BMI, however the study design was judged to be weak [37].…”