Diabetes - Insulin Analogs
The association of diabetes and anti-diabetic medications with clinical outcomes in multiple myeloma
W Wu1,2,9, K Merriman1,9, A Nabaah1, N Seval1, D Seval1, H Lin3, M Wang4, M H Qazilbash5, V Baladandayuthapani3, D Berry3, R Z Orlowski4,6, M-H Lee7 and S-C J Yeung1,8
- 1Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- 2Zhongshan Hospital, Xiamen University, Xiamen, Fujian, People’s Republic of China
- 3Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- 4Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- 5Department of Stem Cell Transplantation, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- 6Department of Experimental Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- 7Department of Molecular and Cellular Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- 8Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
background: Insulin/insulin-like growth factor-1 signalling may underlie the promoting effect of type 2 diabetes on cancer. This study examined the association of diabetes, including steroid-induced diabetes (SID), and the impact of anti-diabetic medication on clinical outcomes of multiple myeloma (MM).
methods: A retrospective review was conducted of 1240 MM patients. Overall survival (OS) and MM disease status prior to death were analysed.
results: Diabetic patients had a significantly shorter OS than non-diabetic patients (median: 65.4 vs98.7 months). In multivariate analysis, SID was a significant predictor of decreased OS, along with age, comorbidity, MM stage, and cytogenetic abnormalities. Analyzing only the diabetic MM patients, Cox regression showed that metformin predicted an increased OS, whereas use of insulin/analogues predicted a decreased OS. Competing risk analysis showed that DM was associated with increased cumulative incidence of death with progressive MM. Among the diabetics, multivariate regression showed that insulin/analogues were associated with increased, but metformin with decreased death with progressive MM. Potential immortal time bias was evaluated by landmark analyses.
conclusions: DM, SID in particular, is associated with poor clinical outcomes in MM. Insulin/analogues are associated with poor outcomes, whereas metformin is associated with improved outcomes. No conclusion about causal relationships can be made at this time. Managing hyperglycaemia with non-insulin regimens should be investigated in randomised trials.
Source : British Journal of Cancer (July 2014)
Link to Abstract