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

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.

SUBMITTER: Crawley D

PROVIDER: S-EPMC5857670 | biostudies-literature | 2018 Mar

REPOSITORIES: biostudies-literature

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

Crawley Danielle D Garmo Hans H Rudman Sarah S Stattin Pär P Zethelius Björn B Armes Jo J Holmberg Lars L Adolfsson Jan J Van Hemelrijck Mieke M

BMJ open 20180316 3

<h4>Objectives</h4>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.<h4>Setting</h4>This study uses observational data from Prostate Cancer database Sweden Traject.<h4>Participants</h4>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 ...[more]

PMID: 29549214

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Project description:BackgroundPoor diabetes management prior to conception, results in increased rates of fetal malformations and other adverse pregnancy outcomes. We describe the development of an integrated, pre-pregnancy management strategy to improve pregnancy outcomes among women of reproductive age with diabetes in a multi-ethnic district.MethodsThe strategy included (i) a narrative literature review of contraception and pre-pregnancy interventions for women with diabetes and development of a draft plan; (ii) a chart review of pregnancy outcomes (e.g. congenital malformations, neonatal hypoglycaemia and caesarean sections) among women with type 1 diabetes (T1D) (n?=?53) and type 2 diabetes (T2D) (n?=?46) between 2010 and 2015 (iii) interview surveys of women with T1D and T2D (n?=?15), and local health care professionals (n?=?13); (iv) two focus groups (n?=?4) and one-to-one interviews with women with T1D and T2D from an Australian background (n?=?5), women with T2D from cultural and linguistically diverse (CALD) (n?=?7) and indigenous backgrounds (n?=?1) and partners of CALD women (n?=?3); and (v) two group meetings, one comprising predominantly primary care, and another comprising district-wide multidisciplinary inter-sectoral professionals, where components of the intervention strategy were finalised using a Delphi approach for development of the final plan.ResultsOur literature review showed that a range of interventions, particularly multifaceted educational programs for women and healthcare professionals, significantly increased contraception uptake, and reduced adverse outcomes of pregnancy (e.g. malformations and stillbirth). Our chart-review showed that local rates of adverse pregnancy outcomes were similarly poor among women with both T1D and T2D (e.g. major congenital malformations [9.1% vs 8.9%] and macrosomia [34.7% vs 24.4%]). Challenges included lack of knowledge among women and healthcare professionals relating to diabetes management and limited access to specialist pre-pregnancy care. Group meetings led to a consensus to develop a district-wide approach including healthcare professional and patient education and a structured approach to identification and optimisation of self-management, including contraception, in women of reproductive age with diabetes.ConclusionsSufficient evidence exists for consensus on a district-wide strategy to improve pre-pregnancy management among women with pre-existing diabetes.

Project description:BackgroundEvidence-based guidance for starting ages of screening for first-degree relatives (FDRs) of patients with prostate cancer (PCa) to prevent stage III/IV or fatal PCa is lacking in current PCa screening guidelines. We aimed to provide evidence for risk-adapted starting age of screening for relatives of patients with PCa.Methods and findingsIn this register-based nationwide cohort study, all men (aged 0 to 96 years at baseline) residing in Sweden who were born after 1931 along with their fathers were included. During the follow-up (1958 to 2015) of 6,343,727 men, 88,999 were diagnosed with stage III/IV PCa or died of PCa. The outcomes were defined as the diagnosis of stage III/IV PCa or death due to PCa, stratified by age at diagnosis. Using 10-year cumulative risk curves, we calculated risk-adapted starting ages of screening for men with different constellations of family history of PCa. The 10-year cumulative risk of stage III/IV or fatal PCa in men at age 50 in the general population (a common recommended starting age of screening) was 0.2%. Men with ≥2 FDRs diagnosed with PCa reached this screening level at age 41 (95% confidence interval (CI): 39 to 44), i.e., 9 years earlier, when the youngest one was diagnosed before age 60; at age 43 (41 to 47), i.e., 7 years earlier, when ≥2 FDRs were diagnosed after age 59, which was similar to that of men with 1 FDR diagnosed before age 60 (41 to 45); and at age 45 (44 to 46), when 1 FDR was diagnosed at age 60 to 69 and 47 (46 to 47), when 1 FDR was diagnosed after age 69. We also calculated risk-adapted starting ages for other benchmark screening ages, such as 45, 55, and 60 years, and compared our findings with those in the guidelines. Study limitations include the lack of genetic data, information on lifestyle, and external validation.ConclusionsOur study provides practical information for risk-tailored starting ages of PCa screening based on nationwide cancer data with valid genealogical information. Our clinically relevant findings could be used for evidence-based personalized PCa screening guidance and supplement current PCa screening guidelines for relatives of patients with PCa.

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Project description:AimsPre-existing cardiovascular disease in general and related risk factors have been associated with poor coronavirus disease-2019 (COVID-19) outcomes. However, data on outcomes of COVID-19 among people with pre-existing diagnosis of heart failure (HF) have not been studied in sufficient detail. We aimed to perform detailed characterization of the association of pre-existing HF with COVID-19 outcomes.Methods and resultsA retrospective cohort study based on Veterans Health Administration (VHA) data comparing 30 day mortality and hospital admission rates after COVID-19 diagnosis among Veterans with and without pre-existing diagnosis of HF. Cox-regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (95% CIs) with adjustment for covariates. Among 31 051 veterans (97% male) with COVID-19, 6148 had pre-existing diagnosis of HF. The mean (SD) age of patients with HF was 70 (13) whereas the mean (SD) age of patients without HF was 57 (17). Within the HF group with available data on left ventricular ejection fraction (EF), 1844 patients (63.4%) had an EF of >45%, and 1063 patients (36.6%) had an EF of ≤45%. Patients in the HF cohort had higher 30 day mortality (5.4% vs. 1.5%) and admission (18.5% vs. 8.4%) rates after diagnosis of COVID-19. After adjustment for age, sex, and race, HRs (95% CIs) for 30 day mortality and for 30 day hospital admissions were 1.87 (1.61-2.17) and 1.79 (1.66-1.93), respectively. After additional adjustment for medical comorbidities, HRs for 30 day mortality and for 30 day hospital admissions were 1.37 (1.15-1.64) and 1.27 (1.16-1.38), respectively. The findings were similar among HF patients with preserved vs. reduced EF, among those taking vs. not taking angiotensin-converting enzyme inhibitors, angiotensin receptor blockers or angiotensin receptor neprilysin inhibitors, and among those taking vs. not taking anticoagulants.ConclusionsPatients with COVID-19 and pre-existing diagnosis of HF had a higher risk of 30 day mortality and hospital admissions compared to those without history of HF. The findings were similar by EF categories and by angiotensin-converting enzyme inhibitors/angiotensin receptor blocker/angiotensin receptor neprilysin inhibitors or anticoagulant use.

Dataset Information

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

Publications

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

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