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Glycosylated haemoglobin and prognosis in 10,536 people with cancer and pre-existing diabetes: a meta-analysis with dose-response analysis
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Glycosylated haemoglobin and prognosis in 10,536 people with cancer and pre-existing diabetes: a meta-analysis with dose-response analysis
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Journal Article
Glycosylated haemoglobin and prognosis in 10,536 people with cancer and pre-existing diabetes: a meta-analysis with dose-response analysis
2022
Overview
Aims
To assess whether glycaemic control is associated with prognosis in people with cancer and pre-existing diabetes.
Methods
In this pre-registered systematic review (PROSPERO: CRD42020223956), PubMed and Web of Science were searched on 25th Nov 2021 for studies investigating associations between glycosylated haemoglobin (HbA
1c
) and prognosis in people with diabetes and cancer. Summary relative risks (RRs) and 95% Confidence Intervals (CIs) for associations between poorly controlled HbA
1c
or per 1-unit HbA
1c
increment and cancer outcomes were estimated using a random-effects meta-analysis. We also investigated the impact of potential small-study effects using the trim-and-fill method and potential sources of heterogeneity using subgroup analyses.
Results
Fifteen eligible observational studies, reporting data on 10,536 patients with cancer and pre-existing diabetes, were included. Random-effects meta-analyses indicated that HbA
1c
≥ 7% (53 mmol/mol) was associated with increased risks of: all-cause mortality (14 studies; RR: 1.14 [95% CI: 1.03–1.27];
p-value
: 0.012), cancer-specific mortality (5; 1.68 [1.13–2.49];
p-value
: 0.011) and cancer recurrence (8; 1.68 [1.18–2.38;
p-value
: 0.004]), with moderate to high heterogeneity. Dose-response meta-analyses indicated that 1-unit increment of HbA
1c
(%) was associated with increased risks of all-cause mortality (13 studies; 1.04 [1.01–1.08];
p-value
: 0.016) and cancer-specific mortality (4; 1.11 [1.04–1.20];
p-value
: 0.003). All RRs were attenuated in trim-and-fill analyses.
Conclusions
Our findings suggested that glycaemic control might be a modifiable risk factor for mortality and cancer recurrence in people with cancer and pre-existing diabetes. High-quality studies with a larger sample size are warranted to confirm these findings due to heterogeneity and potential small-study effects. In the interim, it makes clinical sense to recommend continued optimal glycaemic control.
Highlights
• Diabetes is a common comorbidity in newly-diagnosed cancer patients.
• The impact of glycaemic control in people with both cancer and diabetes is unclear.
• In this meta-analysis, cancer prognosis is worse in those with poor HbA
1c
control.
• More studies with larger sample sizes are warranted to confirm these findings.
• Clinicians should continue to ensure HbA
1c
control in cancer patients with diabetes.
Publisher
BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
