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Does a prostate cancer diagnosis affect management of pre-existing diabetes? Results from PCBaSe Sweden: a nationwide cohort study

Crawley, D, Garmo, H, Rudman, S, Stattin, P, Zethelius, B, Armes, Jo, Holmberg, L, Adolfsson, J and Van Hemelrijck, M (2018) Does a prostate cancer diagnosis affect management of pre-existing diabetes? Results from PCBaSe Sweden: a nationwide cohort study BMJ open, 8 (3), e020787.

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Abstract

Objectives

Both prostate cancer (PCa) and type 2 diabetes mellitus (T2DM) are increasingly prevalent conditions, which frequently coexist in men. Here, we set out to specifically examine the impact of a PCa diagnosis and its treatment on T2DM treatment.

Setting

This study uses observational data from Prostate Cancer database Sweden Traject.

Participants

The study was undertaken in a cohort of 16 778 men with T2DM, of whom 962 were diagnosed with PCa during mean follow-up of 2.5 years.

Primary and secondary outcome measures

We investigated the association between PCa diagnosis and escalation in T2DM treatment in this cohort. A treatment escalation was defined as a new or change in anti-T2DM prescription, as recorded in the prescribed drug register (ie, change from diet to metformin or sulphonylurea or insulin). We also investigated how PCa diagnosis was associated with two treatment escalations. Multivariate Cox proportional hazards regression with age as a time scale was used while adjusting for educational level and initial T2DM treatment.

Results

We found no association between PCa diagnosis and risk of a single treatment escalation (HR 0.99, 95% CI 0.87 to 1.13). However, PCa diagnosis was associated with an increased risk of receiving two consecutive T2DM treatment escalations (HR 1.75, 95% CI 1.38 to 2.22). This increase was strongest for men on gonadotropin-releasing hormone (GnRH) agonists (HR 3.08, 95% CI 2.14 to 4.40). The corresponding HR for men with PCa not on hormonal treatment was 1.40 (95% CI 1.03 to 1.92) and for men with PCa on antiandrogens 0.91 (95% CI 0.29 to 2.82).

Conclusions

Men with T2DM who are diagnosed with PCa, particularly those treated with GnRH agonists, were more likely to have two consecutive escalations in T2DM treatment. This suggests a need for closer monitoring of men with both PCa and T2DM, as coexistence of PCa and its subsequent treatments could potentially worsen T2DM control.

Item Type: Article
Divisions : Faculty of Health and Medical Sciences > School of Health Sciences
Authors :
NameEmailORCID
Crawley, D
Garmo, H
Rudman, S
Stattin, P
Zethelius, B
Armes, Jojo.armes@surrey.ac.uk
Holmberg, L
Adolfsson, J
Van Hemelrijck, M
Date : 16 March 2018
Identification Number : 10.1136/bmjopen-2017-020787
Copyright Disclaimer : Copyright 2018 The Author(s). This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Uncontrolled Keywords : type two diabetes, prostate cancer, review
Depositing User : Melanie Hughes
Date Deposited : 13 Mar 2018 17:35
Last Modified : 11 Apr 2018 07:59
URI: http://epubs.surrey.ac.uk/id/eprint/846011

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