Abstract
Although cancer and diabetes are common diseases, the relationship between diabetes, neuropathy and the risk of developing peripheral sensory neuropathy while or after receiving chemotherapy is uncertain. In this review, we highlight the effects of chemotherapy on the onset or progression of neuropathy in diabetic patients. We searched the literature in Medline and Scopus, covering all entries until 31 January 2021. The inclusion and exclusion criteria were: (1) original article (2) full text published in English or Spanish; (3) neuropathy was specifically assessed (4) the authors separately analyzed the outcomes in diabetic patients. A total of 259 papers were retrieved. Finally, eight articles fulfilled the criteria, and four more articles were retrieved from the references of the selected articles. The analysis of the studies covered the information about neuropathy recorded in 768 cancer patients with diabetes and 5247 control cases (non-diabetic patients). The drugs investigated are chemotherapy drugs with high potential to induce neuropathy, such as platinum derivatives and taxanes, which are currently the mainstay of treatment of various cancers. The predisposing effect of co-morbid diabetes on chemotherapy-induced peripheral neuropathy depends on the type of symptoms and drug used, but manifest at any drug regimen dosage, although greater neuropathic signs are also observed at higher dosages in diabetic patients. The deleterious effects of chemotherapy on diabetic patients seem to last longer, since peripheral neuropathy persisted in a higher proportion of diabetic patients than non-diabetic patients for up to two years after treatment. Future studies investigating the risk of developing peripheral neuropathy in cancer patients with comorbid diabetes need to consider the duration of diabetes, cancer-induced neuropathic effects per se (prior chemotherapy administration), and the effects of previous cancer management strategies such as radiotherapy and surgery.
Highlights
Diabetes mellitus and cancer are among the four most common chronic diseases, and are two of the leading causes of death worldwide [1]
It is well known that high blood glucose can damage peripheral nerves [10,11]; as such, patients with diabetes who are treated with chemotherapy drugs may be at greater risk of developing chemotherapy-related peripheral neuropathy [12]
Two researchers independently summarized the results which emerged from this literature review under four headings: (1) characteristics of the studies; (2) prevalence and severity of neuropathy in diabetic patients compared to non-diabetic patients after chemotherapy; (3) severity of neuropathy and type of chemotherapeutic drugs in diabetic versus non-diabetic patients; (4) variables affecting the relationship between occurrence and severity of neuropathy in diabetic patients
Summary
Diabetes mellitus and cancer are among the four most common chronic diseases, and are two of the leading causes of death worldwide [1]. Diabetes mellitus is a commonly encountered comorbidity among patients with solid tumors [6,7,8]. Diabetes mellitus and its accompanying metabolic syndrome have been shown to correlate with the development and outcomes of a number of solid tumors [6,7,9]. It is well known that high blood glucose can damage peripheral nerves [10,11]; as such, patients with diabetes who are treated with chemotherapy drugs may be at greater risk of developing chemotherapy-related peripheral neuropathy [12]. Because peripheral neuropathy is commonly observed in patients with diabetes, most studies of chemotherapy-induced peripheral neuropathy exclude patients with diabetes [5]. Information regarding a pre-existing history of diabetes was not available in this study [13]
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