Good glycaemic control is associated with a better prognosis in breast cancer patients with type 2 diabetes mellitus

Abstract

Although diabetes mellitus (DM) is one of the risk factors associated with increased breast cancer (BC) mortality, the effects of glycaemic control on the prognosis of BC have not been thoroughly evaluated. This retrospective study aimed to evaluate the relationship between glycaemic control and BC prognosis and to determine an optimal target of glycaemic control for BC patients with diabetes. We included 2812 stage 0-3 BC women, of whom 145 were diabetic and were 2667 non-diabetic. In those with diabetes, a mean haemoglobin A1C (HbA1C) < 7% (n = 77) was defined as well-controlled diabetes, while a mean HbA1C > 9% (n = 16) was defined as poorly controlled diabetes. All of the BC populations were followed from the date on which BC was diagnosed until 31 December 2015. Cox regression analysis was performed to estimate the adjusted hazards for all-cause mortality and BC-specific mortality. After controlling for the baseline and BC-related confounders, the adjusted hazard ratio (HR) for all-cause mortality and the HR for BC-specific mortality were 3.65 (95% confidence interval [95% CI] 1.13-11.82) and 8.37 (95% CI 1.90-36.91), respectively, for poorly controlled diabetic women and non-DM women. However, for the diabetic women with good glycaemic control, the HRs of all-cause mortality and BC-specific mortality were not significantly different (HR 0.91, 95% CI 0.42-1.01; HR 0.77, 95% CI 0.18-3.32, respectively) from those for both mortalities in non-DM patients. For moderate controlled diabetic women, the HRs for all-cause mortality and BC-specific mortality were 1.95 (95% CI 0.89-4.27) and 3.55 (95% CI 1.369-9.30), respectively. This pilot and retrospective cohort study reveals a relationship between glycaemic control and BC prognosis in diabetic women. In addition, well-controlled HbA1C, with maintained mean HbA1C values under 7%, may be associated with a better progression outcome of BC.

Phase 1 lead‐in to a phase 2 factorial study of temozolomide plus memantine, mefloquine, and metformin as postradiation adjuvant therapy for newly diagnosed glioblastoma

“…Metformin is another drug with possible antitumor effects in various solid tumors. Metformin is used primarily in the treatment of diabetes, which is a known independent risk factor for cancer . A recent retrospective study indicated that diabetic patients with breast cancer who received metformin incidentally with neoadjuvant chemotherapy had a higher pathologic complete response rate .…”

“…Metformin is used primarily in the treatment of diabetes, which is a known independent risk factor for cancer. 22 A recent retrospective study indicated that diabetic patients with breast cancer who received metformin incidentally with neoadjuvant chemotherapy had a higher pathologic complete response rate. 23 Preclinical studies have reported that metformin has a dual antiglioma effect, blocking cell cycle progression through decreasing cyclin D1 expression and inducing apoptosis.…”

The impact of preoperative glycated hemoglobin levels on outcomes in oral squamous cell carcinoma

“…Higher HbA1c as an independent risk factor for developing site‐specific cancer has been established (Hope, Robertshaw, Cheung, Idris, & English, 2016). Further studies have also demonstrated elevated mortality risks from certain cancers, including breast and colorectal cancers, in patients with increasing HbA1c values (Chang, Sheu, Lin, & Liou, 2018; Ferroni et al., 2016; Joshu et al., 2012; Silbernagel, Grammer, Winkelmann, Boehm, & Marz, 2011). Despite the mounting evidence illustrating the association of HbA1c and cancer risk and prognosis, there is no existing study to our knowledge that has explored the association of HbA1c levels and the risks of head and neck cancer or OSCC specifically.…”

Insulin glargine use and breast cancer: a systematic review and meta-analysis

“…Recent literature found that women with diabetes have higher breast cancer-related mortality than their counterparts without diabetes (5). Furthermore, poor glycemic control was found to be associated with poor prognosis among patients with breast cancer, a recent study suggested a genetic polymorphism that predispose to diabetes and the risk of developing and dying from breast cancer (6,7). Insulin glargine available in Gla-100 and Gla-300 concentrations is associated with lower risk of hypoglycemia, and weight gain compares to other types of insulin, but concern is raised due to its mitogenic potential, especially as regards breast cancer (8).…”