Pre-existing diabetes mellitus in patients with multiple myeloma
Pre-existing diabetes mellitus in patients with multiple myeloma
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DOI：
10.1111/j.1600-0609.2012.01828.x
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发表时间：
2012-10-01
影响因子：
3.1
通讯作者：
Hsiao, Liang-Tsai
中科院分区：
文献类型：
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作者：
Chou, Yi-Sheng;Yang, Ching-Fen;Hsiao, Liang-Tsai
2型糖尿病在诊断为多发性骨髓瘤（MM）的患者中约占10%，并且与新型抗骨髓瘤药物引起的不良事件风险增加相关。然而，2型糖尿病对MM患者生存的影响尚未研究。方法选取1999年至2007年台北荣民总医院新诊断的MM患者，并筛选出既往患有糖尿病的患者。通过比较有糖尿病和无糖尿病患者的临床特征、治疗方法和与血糖控制和总生存期（OS）相关的不良反应，评估既往糖尿病对MM患者的影响。结果310例MM患者中，73%为男性，40例（12.9%）既往患有糖尿病。与非糖尿病患者相比，已存在糖尿病的MM患者在诊断时出现肾功能损害的比例[(RI)，血清肌酐=2.0相似于mg/dL]和国际分期系统III期的比例明显较高，双膦酸盐使用比例和RI逆转率明显较低（P相似于=相似于0.087）。在病程中，分别有23例（67.6%）和6例（17.6%）患者出现高血糖和低血糖。34例可评估患者中有10例（29.4%）改变了抗糖尿病治疗。合并糖尿病的MM患者的全因死亡率明显高于非糖尿病患者（风险比为1.509；95%可信区间为1.0232.225,P = 0.037）。结论：本研究证实了既往糖尿病对MM患者临床特征和OS的影响。
Objectives Type 2 diabetes mellitus is present in approximately 10% of patients at diagnosis of multiple myeloma (MM) and is associated with increased risks of adverse events caused by novel antimyeloma agents. However, the impact of type 2 diabetes on the survival of patients with MM has not been studied. Methods We enrolled newly diagnosed patients with MM in Taipei Veterans General Hospital between 1999 and 2007 and identified those with pre-existing diabetes. The impact of pre-existing diabetes on patients with MM was evaluated by comparing clinical features, treatments and adverse reactions related to glycaemic control and overall survival (OS) of patients with and without pre-existing diabetes. Results Of 310 patients with MM, 73% were men and 40 (12.9%) had pre-existing diabetes. Compared with their non-diabetic counterparts, MM patients with pre-existing diabetes had a significantly higher proportion of renal impairment [(RI), serum creatinine =2.0 similar to mg/dL] and International Staging System stage III at diagnosis, and a significantly lower proportion of bisphosphonate use and a lower rate of RI reversal (P similar to=similar to 0.087). During the course of the disease, hyperglycaemia and hypoglycaemia of any grade were noted in 23 (67.6%) and 6 (17.6%) of these patients, respectively. Antidiabetic therapy was changed in 10 (29.4%) of 34 evaluable patients. MM patients with pre-existing diabetes had a significantly higher all-cause mortality risk (hazard ratio, 1.509; 95% confidence interval, 1.0232.225, P similar to=similar to 0.037) compared with their non-diabetic counterparts. Conclusions Our study demonstrated the impact of pre-existing diabetes on clinical features and OS in patients with MM.