TY - JOUR
T1 - The association of diabetes and anti-diabetic medications with clinical outcomes in multiple myeloma
AU - Wu, W.
AU - Merriman, K.
AU - Nabaah, A.
AU - Seval, N.
AU - Seval, D.
AU - Lin, H.
AU - Wang, M.
AU - Qazilbash, M. H.
AU - Baladandayuthapani, V.
AU - Berry, D.
AU - Orlowski, R. Z.
AU - Lee, M. H.
AU - Yeung, S. C.J.
N1 - Funding Information:
This work was supported by a grant from Susan G Komen for the Cure (PROMISE grant KG081048), and a Developmental Research Program Award of The MD Anderson Cancer Center SPORE in MM (National Cancer Institute P50 CA142509, PI: R Orlowski) to SC Yeung and MH Lee. W Wu was supported by Health Professional Training Grant from Department of Health of Fujian Province, China, and Grant from Xiamen Public Health Bureau for Science and technology project (3502z20077042 and WQK0605). The University of Texas MD Anderson Cancer Center was supported by a National Institutes of Health Cancer Center Support Grant (CA16672).
PY - 2014/7/29
Y1 - 2014/7/29
N2 - 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 vs 98.7 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.
AB - 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 vs 98.7 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.
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U2 - 10.1038/bjc.2014.307
DO - 10.1038/bjc.2014.307
M3 - Article
C2 - 24921909
AN - SCOPUS:84905226036
SN - 0007-0920
VL - 111
SP - 628
EP - 636
JO - British journal of cancer
JF - British journal of cancer
IS - 3
ER -