Articles

Androgen-deprivation Therapy and Diabetes Control Among Diabetic Men with Prostate Cancer

By: Nancy L. Keating a b lowast , Pang-Hsiang Liu b , A. James O’Malley b , Stephen J. Freedl, c d and Matthew R. Smith e

Published online: 01 April 2014

Keywords: Prostate cancer, Androgen-deprivation therapy, Diabetes

Abstract Full Text Full Text PDF (411 KB)

Abstract

Background

Androgen-deprivation therapy (ADT) for prostate cancer (PCa) is associated with decreased insulin sensitivity and increased diabetes risk among nondiabetic men. Few data are available about the effects of ADT on diabetes control among men with diabetes.

Objective

We examined care for men who had diabetes at the time of PCa diagnosis to assess the effect of ADT on diabetes control, as measured by hemoglobin A1c (HbA1c) levels and the intensification of diabetes pharmacotherapy.

Design, setting, and participants

This was an observational cohort study using US Department of Veterans Affairs registry data and administrative data to assess HbA1c levels and intensification of diabetes pharmacotherapy among 2237 pairs of propensity-matched men with PCa and diabetes who were or were not treated with ADT.

Outcome measurements and statistical analysis

We calculated the difference in difference of HbA1c levels at baseline and at 1 and 2 yr in the two groups, compared using a paired Student t test. We used a Cox proportional hazards model to estimate time to intensification of diabetes pharmacotherapy.

Results and limitations

The mean HbA1c at baseline was 7.24 (standard error [SE]: 0.05) for the ADT group and 7.24 (SE: 0.04) for the no-ADT group. HbA1c increased at 1 yr for men treated with ADT to 7.38 (SE: 0.04) and decreased among men not treated with ADT to 7.14 (SE: 0.04), for a difference in differences of +0.24 (p = 0.008). Results were similar at 2 yr (p = 0.03). The worsening HbA1c control occurred despite ADT being associated with an increased hazard of addition of diabetes medication (adjusted hazard ratio: 1.20; 95% confidence interval, 1.09–1.32). The limitation of this study was that it was observational and relied on administrative data.

Conclusions

ADT is associated with worsening of diabetes control and increases in HbA1c levels despite the use of additional diabetes medications.

Take Home Message

Androgen-deprivation therapy for prostate cancer is associated with worsening of diabetes control and increases in hemoglobin A1c levels despite the use of additional diabetes medications.

Keywords: Prostate cancer, Androgen-deprivation therapy, Diabetes.

Footnotes

a Division of General Internal Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA

b Department of Health Care Policy, Harvard Medical School, Boston, MA, USA

c Division of Urology, Department of Surgery, Duke University School of Medicine, Durham, NC, USA

d Durham Veterans Affairs Medical Center, Durham, NC, USA

e Division of Hematology and Oncology, Massachusetts General Hospital, Boston, MA, USA

lowast Corresponding author. Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115, USA. Tel. +1 617 432 3093; Fax: +1 617 432 0173.