Association Between Androgen-Deprivation Therapy And Incidence Of Diabetes Among Males With Prostate Cancer

Main Category: Prostate / Prostate Cancer
Also Included In: Urology / Nephrology;  Men's health
Article Date: 24 Feb 2008 - 0:00 PDT

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UroToday.com - A report in the December, 2007 issue of Urology by M.J. Lange and associates links androgen-deprivation therapy (ADT) for prostate cancer (CaP) to incident diabetes mellitus (DM). The study rationale is based upon knowledge that ADT is associated with loss of lean body mass, increase of fat body mass, hyperglycemia, and insulin resistance.

An administrative claims database was used to identify men having CaP between 2000 and 2005. Men were eligible if they received an outpatient prescription for an LHRH agonist, an LHRH antagonist, an anti-androgen, or other androgen-suppressing therapy. A control group included men with CaP who did not receive ADT. Both groups were correlated with coding for a new diagnosis of DM.

A total of 8,481men were included in the analysis. Mean age was 65 years, the majority resided in the southern US (51%) and 29% were insured with Medicare. The most common comorbid conditions were hypertension (38%) and cardiovascular disease (21%). Men who received ADT were 1.5 years older and in worse health by the Charlson comorbidity score than those who had CaP and did not receive it. Patient age was associated with a higher relative risk of incident DM increase but a lower relative risk of incident DM was noted for those residing in the Midwest as compared to the south. A diagnosis of congestive heart failure or hypertension in the pre-period, in addition to statin use was associated with a significantly higher relative risk of incident DM. After controlling for demographic data, general health status, comorbidities, and statin use, men diagnosed with CaP who received ADT had a significantly higher risk of being diagnosed with DM in the 12-month post-period. The relative risk was 1.36 times higher than men with CaP who did not receive ADT.

The authors acknowledge that study limitations include the use of an administrative claims database that includes only patients with medical and prescription benefit coverage contained within that database. The diagnostic codes used to obtain the results are not as direct as formal individual patient assessments. None the less, the findings are consistent with other known data regarding use of ADT and mechanisms contributing to metabolic syndrome.

Lage MJ, Barber BL, Markus RA

Urol. 70(6):1104-08, December 2007
doi:10.1016/j.urology.2007.08.012

Reported by UroToday.com Contributing Editor Christopher P. Evans, MD

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