PMID- 29549214 OWN - NLM STAT- MEDLINE DCOM- 20180907 LR - 20190202 IS - 2044-6055 (Electronic) IS - 2044-6055 (Linking) VI - 8 IP - 3 DP - 2018 Mar 16 TI - Does a prostate cancer diagnosis affect management of pre-existing diabetes? Results from PCBaSe Sweden: a nationwide cohort study. PG - e020787 LID - 10.1136/bmjopen-2017-020787 [doi] LID - e020787 AB - 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. CI - (c) Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted. FAU - Crawley, Danielle AU - Crawley D AUID- ORCID: 0000-0001-7294-5634 AD - School of Cancer and Pharmaceutical Sciences, Translational Oncology and Urology Research (TOUR), King's College London, London, UK. FAU - Garmo, Hans AU - Garmo H AD - School of Cancer and Pharmaceutical Sciences, Translational Oncology and Urology Research (TOUR), King's College London, London, UK. FAU - Rudman, Sarah AU - Rudman S AD - Comprehensive Biomedical Research Centre, Guy's and St Thomas' NHS Foundation Trust and King's College London's, London, UK. FAU - Stattin, Par AU - Stattin P AD - Department of Surgical Sciences, Uppsala University, Uppsala, Sweden. FAU - Zethelius, Bjorn AU - Zethelius B AD - Department of Public Health and Geriatric, Uppsala University, Uppsala, Sweden. AD - Medical Products Agency, Uppsala, Sweden. FAU - Armes, Jo AU - Armes J AD - Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, UK. FAU - Holmberg, Lars AU - Holmberg L AD - School of Cancer and Pharmaceutical Sciences, Translational Oncology and Urology Research (TOUR), King's College London, London, UK. FAU - Adolfsson, Jan AU - Adolfsson J AD - Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, UK. AD - Department of Clinical Science, Intervention and Technology, Karolinska Insituet, Stockholm, Sweden. FAU - Van Hemelrijck, Mieke AU - Van Hemelrijck M AD - School of Cancer and Pharmaceutical Sciences, Translational Oncology and Urology Research (TOUR), King's College London, London, UK. LA - eng PT - Journal Article PT - Observational Study PT - Research Support, Non-U.S. Gov't DEP - 20180316 PL - England TA - BMJ Open JT - BMJ open JID - 101552874 RN - 0 (Hypoglycemic Agents) RN - 33515-09-2 (Gonadotropin-Releasing Hormone) SB - IM MH - Aged MH - Comorbidity MH - Diabetes Mellitus, Type 2/*drug therapy MH - Gonadotropin-Releasing Hormone/therapeutic use MH - Humans MH - Hypoglycemic Agents/therapeutic use MH - Male MH - Middle Aged MH - Proportional Hazards Models MH - Prostatic Neoplasms/*diagnosis MH - Risk Factors MH - Sweden PMC - PMC5857670 OTO - NOTNLM OT - Glycaemic control OT - insulin OT - metformin OT - prostate cancer OT - sulphonylurea OT - type two diabetes COIS- Competing interests: None declared. EDAT- 2018/03/20 06:00 MHDA- 2018/09/08 06:00 PMCR- 2018/03/16 CRDT- 2018/03/18 06:00 PHST- 2018/03/18 06:00 [entrez] PHST- 2018/03/20 06:00 [pubmed] PHST- 2018/09/08 06:00 [medline] PHST- 2018/03/16 00:00 [pmc-release] AID - bmjopen-2017-020787 [pii] AID - 10.1136/bmjopen-2017-020787 [doi] PST - epublish SO - BMJ Open. 2018 Mar 16;8(3):e020787. doi: 10.1136/bmjopen-2017-020787.