Prevalenci sladkorne bolezni in demence v zadnjih letih naraščata, bolezni pa si delita številne dejavnike tveganja, kot so hipertenzija, dislipidemija, čezmerna telesna teža, nezdrava prehrana in ...telesna neaktivnost. Pomanjkanje glikemičnega nadzora se povezuje z višjim tveganjem za kognitivni upad, mikrožilni in makrožilni zapleti sladkorne bolezni pa z višjim tveganjem za razvoj demence. Bolniki s sladkorno boleznijo imajo oškodovane različne kognitivne domene. Posebej izrazite so težave na področju spomina in izvršilnih funkcij. Tovrstne težave lahko vplivajo na potek sladkorne bolezni, posameznikove možnosti uvida v lastno bolezen in sposobnosti sledenja režimu zdravljenja. Kognitivne motnje pri bolnikih s sladkorno boleznijo se povezujejo s slabšim znanjem in slabšo skrbjo za lastno bolezen, pogostejšimi napakami pri spremljanju krvne glukoze in odmerjanju inzulinskih injekcij, pogosteje zamujenimi zdravstvenimi pregledi in večjim številom epizod hipoglikemije ter srčnožilnih zapletov. Pomembno je, da pri bolnikih s sladkorno boleznijo prepoznamo kognitivne težave in jih upoštevamo pri načrtovanju zdravljenja; opredelitvi tarčnih vrednosti, edukaciji, izbiri farmakoloških in nefarmakoloških načinov zdravljenja ter nudenju podpore bolnikom in njihovim svojcem oziroma skrbnikom. Pomembni so individualni pristop, postopno uvajanje sprememb in čim bolj enostaven protokol zdravljenja (npr. uporaba zdravil s podaljšanim učinkom, uporaba razdelilcev zdravil), ki upoštevajo tudi socialno situacijo posameznika.
Objective: Colorectal cancer surgery is often followed by postoperative complications which may impact survival. Diabetes mellitus (DM) and DM related comorbidities may initiate difficulties during ...cancer specific treatment and may have an impact on cancer management and outcome. The aim of our study was to find out if DM in patients with advanced colorectal carcinoma is associated with cancer-specific and overall survival.
Material and Methods: This study included 200 consecutive patients (131 males, 69 females, mean age 63 years) with elective colorectal cancer surgery at the Institute of Oncology Ljubljana from September 2010 to March 2013. Even 64% of patients had Stage 3 or 4 disease, so neo-adjuvant chemotherapy and/or radiotherapy were carried out in 59% of cases. DM was found in 39 (19.5%) patients. Data about gender, age, body mass index, presence of DM, American Society of Anesthesiologists (ASA) physical status score, stage of disease and postoperative complications were collected prospectively. Univariate survival analysis was used to identify factors correlated with disease-specific and overall survival.
Results: Patients with DM had higher ASA score and BMI than those without DM. Rectum, colon and both of them were affected by cancer in 68%, 30% and 2% of cases, respectively. Stage 3 or 4 disease was found in patients with DM and without DM in 62% and 65%, respectively. Mean follow-up period was 4.75 years. Recurrence was diagnosed in 23% of patients with DM and in 25% of patients without DM. Altogether 41 patients died of cancer and 12 patients of other causes. Three-year cancer-specific survival in patients with DM and without DM was 85% and 89%, respectively (p=0.68). Three-year overall survival in patients with DM and without DM was 82% and 84%, respectively (p=0.63).
Conclusions: Presence of DM was not associated with tumor stage, disease-specific survival or overall survival in our group of patients with advanced colorectal carcinoma.
Disclosure
N. Satej: Speaker's Bureau; Self; Novo Nordisk Inc., Sanofi, AstraZeneca. N. Besic: Speaker's Bureau; Spouse/Partner; Novo Nordisk Inc., AstraZeneca, Sanofi. A. Pavlic: None. M. Kerin Povsic: None.
Recent epidemiological studies have suggested that some insulin analogues could be associated with an increased risk of cancer. The aim of this retrospective study was to examine whether patients ...with diabetes mellitus (DM) using insulin glargine have a higher tumor stage of breast carcinoma in comparison to patients using other types of insulin.
We performed a chart review of 79 surgically treated breast carcinoma patients (mean age of 66.5 years; range 38-86 years) who were on insulin. Insulin glargine was used in 13 patients, while the other 66 patients were on other types of insulin. Clinical and histopathology characteristics of patients on glargine versus other types of insulin were compared using a chi-square test and non-parametric statistical analysis.
DM type 1 and DM type 2 was present in 14 and 65 patients, respectively. The mean tumor size was 2.98 cm. The TNM tumor stage at diagnosis was not higher among patients on glargine compared to patients on other types of insulin (T1/T2 85% vs. 68%, T3/T4 15% vs. 32%, p = 0.32; N1 54% vs. 58%, p = 0.80; M1 8% vs. 6%, respectively). No significant differences between both study groups (glargine vs. other types of insulin) were found in the ages of the patients, their BMI, tumor histology, grade, number of metastatic lymph nodes, hormone receptors or HER-2 status.
We could not show that patients with DM using insulin glargine have a higher tumor stage of breast carcinoma in comparison to those using other types of insulin.
Abstract only
165
Background: Although both diabetes mellitus (DM) and breast carcinoma (BC) are common diseases, the data about histopathology characteristics and extent of disease of these patients ...in the literature are scarce and conflicting. Metformin may exhibit inhibitory effects on cancer cells by inhibiting mTOR signaling pathway. Our hypothesis was that use of metformin has an impact on slower progression of breast carcinoma in comparison to other types of anti-diabetic drugs. The aim of our retrospective study was to examine if the patients with BC and DM receiving metformin have lower tumor stage in comparison to patients not receiving metformin. Methods: A chart review of 252 patients (mean age 66.6; range 38-93 years) with invasive BC and DM was performed. They were surgically treated at our institute from 2005-2011. Data on clinical and histopathology factors were collected. Statistical analysis of these factors (i.e., comparison of metformin group vs. no metformin group) was performed by contingence tables and non-parametric tests. Results: DM type 1 and DM type 2 was present in 14 and 238 cases, respectively. Altogether 126 patients were on metformin, while 126 were not receiving metformin. Larger proportion of patients on metformin in comparison to patients not receiving metformin was younger than 71 years of age (p<0.05). No statistical difference between the study groups (metformin vs. no metformin) were found in TNM stage (T1: 48% vs. 46%; T2: 36% vs. 28%; T3: 7% vs. 5%; T4: 9% vs. 21%, p=0.071; N0: 51% vs. 50%, N1 49% vs. 50%; M0: 97% vs. 97.5%, M1: 3% vs. 4%, p=0.74, respectively). However, patients on metformin had lower proportion of T3 or T4 tumors than patients who were not receiving metformin (16% vs. 26%; p<0.05). Patients on metformin had lower rate of lobular carcinoma than patients who were not receiving metformin (9.5% vs. 19%; p<0.05). Tumor size, tumor grade, mean number of metastatic lymph nodes, hormone receptor status or HER-2 status did not show any statistical difference between both study groups. Conclusions: Patients with BC and DM on metformin have lower proportion of T3 or T4 tumors and lower proportion of lobular carcinoma in comparison to patients not receiving metformin.
Metformin may exhibit inhibitory effects on cancer cells by inhibiting mTOR signaling pathway. The aim of our retrospective study was to examine if patients with breast carcinoma (BC) and diabetes ...mellitus (DM) receiving metformin have a lower stage of carcinoma in comparison to patients not receiving metformin, and if the use of metformin correlates with the molecular subtype of BC.
A chart review of 253 patients with invasive BC and DM (128 on metformin and 125 not on metformin) was performed. Control group consisted of 320 consecutive patients with invasive BC without DM. BC subtypes were classified by immunohistochemical surrogates as luminal A (estrogen receptor ER + and/or progesterone receptor PR+, HER-2-), luminal B (ER + and/or PR+, HER-2+), HER-2 (ER-, PR-, HER-2+), triple-negative/basal (ER-, PR-, HER-2-).
Patients on metformin had a lower proportion of T3 or T4 tumors than patients who were not receiving metformin (16% vs. 26%; p = 0.035). No statistical difference was found between the two study groups in N stage. Patients with DM on metformin, with DM not on metformin and the control group had different molecular subtypes of BC (p = 0.01): the luminal A subtype was found in 78%, 83% and 71%, the luminal B in 12.6%, 9% and 11%, HER-2 in 0.8%, 1.6% and 8%, and the triple-negative/basal-like subtype in 8.6%, 6.4% and 10%, respectively.
Our data indicate that long-term use of metformin use correlates with molecular subtype of BC in diabetics on metformin in comparison to diabetics not on metformin and patients without DM. However, most likely, different distribution of the molecular subtypes of BC in these three groups of patients was caused by other risk factors for breast carcinoma, such as age of patients or obesity.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
PDF
