Incidence and disease course of new-onset diabetes mellitus in breast and colorectal cancer patients undergoing chemotherapy: A prospective multicenter cohort study

  • Author Footnotes
    1 These two authors contributed equally to this work.
    Eun Kyung Lee
    Footnotes
    1 These two authors contributed equally to this work.
    Affiliations
    Department of Internal Medicine, National Cancer Center, Goyang, Republic of Korea

    Center for Thyroid Cancer, National Cancer Center, Goyang, Republic of Korea
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  • Author Footnotes
    1 These two authors contributed equally to this work.
    Bokyung Koo
    Footnotes
    1 These two authors contributed equally to this work.
    Affiliations
    Division of Endocrinology, Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Republic of Korea

    Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
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  • Yul Hwangbo
    Affiliations
    Department of Internal Medicine, National Cancer Center, Goyang, Republic of Korea

    Center for Thyroid Cancer, National Cancer Center, Goyang, Republic of Korea
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  • You Jin Lee
    Affiliations
    Department of Internal Medicine, National Cancer Center, Goyang, Republic of Korea

    Center for Thyroid Cancer, National Cancer Center, Goyang, Republic of Korea
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  • Ji Yeon Baek
    Affiliations
    Department of Internal Medicine, National Cancer Center, Goyang, Republic of Korea

    Center for Colorectal Cancer, National Cancer Center, Goyang, Republic of Korea
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  • Yong Jun Cha
    Affiliations
    Department of Internal Medicine, National Cancer Center, Goyang, Republic of Korea

    Center for Colorectal Cancer, National Cancer Center, Goyang, Republic of Korea
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  • Sun Young Kim
    Affiliations
    Department of Internal Medicine, National Cancer Center, Goyang, Republic of Korea

    Center for Colorectal Cancer, National Cancer Center, Goyang, Republic of Korea
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  • Sung Hoon Sim
    Affiliations
    Department of Internal Medicine, National Cancer Center, Goyang, Republic of Korea

    Center for Breast Cancer, National Cancer Center, Goyang, Republic of Korea
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  • Keun Seok Lee
    Affiliations
    Department of Internal Medicine, National Cancer Center, Goyang, Republic of Korea

    Center for Breast Cancer, National Cancer Center, Goyang, Republic of Korea
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  • In Hae Park
    Affiliations
    Department of Internal Medicine, National Cancer Center, Goyang, Republic of Korea

    Center for Breast Cancer, National Cancer Center, Goyang, Republic of Korea
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  • Hyewon Lee
    Affiliations
    Department of Internal Medicine, National Cancer Center, Goyang, Republic of Korea
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  • Jungnam Joo
    Affiliations
    Office of Biostatistics Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, USA
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  • Sujeong Go
    Affiliations
    Center for Thyroid Cancer, National Cancer Center, Goyang, Republic of Korea
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  • Seung Chul Heo
    Affiliations
    Department of Surgery, Seoul National University Boramae Medical Center, Seoul, Republic of Korea
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  • Min Kyong Moon
    Correspondence
    Corresponding author at: Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Boramae Medical Center, 20 Boramae-ro 5-gil, Dongjak-gu, Seoul 07061, Republic of Korea.
    Affiliations
    Division of Endocrinology, Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Republic of Korea

    Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
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  • Author Footnotes
    1 These two authors contributed equally to this work.

      Highlights

      • We investigated hyperglycemia that occurs during chemotherapy causing poor outcomes.
      • New-onset diabetes mellitus incidence was 6.3% in cancer patients receiving chemotherapy with dexamethasone.
      • Risk factors of new-onset diabetes mellitus were male and underlying impaired fasting glucose.
      • After the end of chemotherapy, new-onset diabetes mellitus remitted in 64.7% patients.
      • We found that remission was associated with higher C-peptide level at baseline.

      Abstract

      Aims

      To investigate the incidence of and risk factors for new-onset type 2 diabetes mellitus (DM) developed during chemotherapy that included steroids in cancer patients without DM.

      Methods

      This multicenter, prospective, and observational cohort study enrolled 299 cancer patients without DM (aged > 18 years), planning 4–8 cycles of adjuvant chemotherapy. The endpoints were the incidence, remission rate, and independent determinants of new-onset DM during chemotherapy.

      Results

      Between April 2015 and March 2018, 270 subjects with colorectal cancer or breast cancer (mean age, 51.0 years) completed the follow up (mean 39 months). Of whom, 17 subjects (6.3%) developed DM within a median time of 90 days (range, 17–359 days). Male sex (hazard ratio [HR], 15.839; 95% confidence interval [CI], 2.004–125.20) and impaired fasting glucose (IFG) at baseline (HR, 8.307; CI, 1.826–37.786) were independent risk factors. Six months after chemotherapy completion, 11/17 subjects (64.7%) experienced DM remission, associated with a significantly higher C-peptide level at baseline (C-peptide levels, 1.3 ng/mL in subjects with remission and 0.9 ng/mL in subjects without remission, age- and sex-adjusted P = 0.007).

      Conclusions

      DM incidence was 6.3% in patients who received chemotherapy with dexamethasone. Close monitoring for hyperglycemia is recommended, especially for men with IFG.
      Trial registration: ClinicalTrials.gov (NCT03062072).

      Keywords

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