Glycemic Variability Within 1 Year Following Surgery for Stage II–III Colon Cancer

Abstract

Objective: To examine glycemic variability within 1 month and 1 year following surgery among adult patients, with and without Type 2 Diabetes (T2D), treated for stage II-III colon cancer. Method: A retrospective analysis of electronic health record data was conducted. Glycemic variability (i.e., standard deviation [SD] and coefficient of variation [CV] of > 2 blood glucose measures) was assessed within 1 month and within 1 year following colon surgery. Chi-square (χ2), Fisher’s exact, and Mann-Whitney U tests were used for the analyses. Results: Among the sample of 165 patients with stage II–III colon cancer, those with T2D had higher glycemic variability compared to patients without T2D ( p < .001), with values within 1 month following surgery (SD = 44.69 mg/dL, CV = 27.4%) vs (SD = 20.55 mg/dL, CV = 17.53%); and within 1 year following surgery (SD = 45.04 mg/dL, CV = 29.04%) vs (SD = 21.36 mg/dL, CV = 18.6%). Associations were found between lower body mass index and higher glycemic variability (i.e., SD [r = −.413, p < .05] and CV [r = −.481, p < .01]) within 1 month following surgery in patients with T2D. Higher preoperative glucose was associated with higher glycemic variability (i.e., SD r = .448, p < .01) within 1 year in patients with T2D. Demographic and clinical characteristics were weakly associated with glycemic variability in patients without T2D. Conclusions: Patients with stage II–III colon cancer with T2D experienced higher glycemic variability within 1 month and within 1 year following surgery compared to those without T2D. Associations between glycemic variability and demographic and clinical characteristics differed by T2D status. Further research in prospective studies is warranted.

Glycemic Variability in Patients With Stage II–III Colon Cancer Treated With Surgery and Adjuvant Chemotherapy

“…Patients with T2D also had significantly higher glycemic variability throughout chemotherapy at each assessment. These findings are consistent with the literature, suggesting that patients with T2D have higher glycemic variability compared to those without T2D (Gude et al, 2017;Mandolfo et al, 2020Mandolfo et al, , 2022Suh & Kim, 2015). Patients without T2D experienced a significant change in glycemic variability over the course of 12 cycles of chemotherapy, despite experiencing overall lower glycemic variability compared to those with T2D.…”

“…Glycemic variability occurs in patients with cancer with and without T2D; however, it has been reported to be higher among patients with T2D (Gude et al, 2017;Mandolfo et al, 2020Mandolfo et al, , 2022Suh & Kim, 2015). Of note, poor health outcomes have been associated with glycemic variability in hospitalized patients (Akirov et al, 2019;Atamna et al, 2019;Singh et al, 2018) and in patients with congestive heart failure (Gu et al, 2018), vascular complications (Gorst et al, 2015), diabetic neuropathy (Cheng et al, 2014;Lai et al, 2019), end-stage renal disease (Yang et al, 2015), and cognitive decline (Yu et al, 2019).…”

“…Lastly, the complexity involved in colon cancer surgery and chemotherapy treatment may negatively affect a patient's ability to selfmanage T2D (Lund et al, 2021). Mandolfo et al (2022) reported that patients with T2D experienced higher glycemic variability within one month to one year following surgery for colon cancer compared to patients without T2D. The authors did not find published reports of glycemic variability during adjuvant chemotherapy for the treatment of stage II-III colon cancer.…”