Glycemia Control Using A1C Level in Terminal Cancer Patients with Preexisting Type 2 Diabetes

Abstract

No method is available for evidence-based glycemic-control management in the context of advanced cancer. This study aimed to analyze, by investigating A1C levels, the necessity of glycemic control in terminal cancer patients with preexisting type 2 diabetes. This was a retrospective study. We analyzed 53 terminal cancer patients who had preexisting type 2 diabetes. All patients first visited Kondo Hospital between April 2002 and December 2006. We assessed the necessity of glycemic control based on the length of hospitalization and the length of the end-of-life period by using the Kaplan-Meier method and Cox hazard model. Length of the end-of-life period was calculated from the completion of palliative chemotherapy until death. Length of hospitalization was calculated from last admission until death. The median length of hospitalization was significantly longer in relatively well controlled patients--with A1C levels <7.5% (49 days; 95% confidence interval [CI] 34.9-63.1)--than in poorly controlled patients, with A1C levels ≥7.5% (23 days; 95% CI 14.6-31.4, P=0.05). The median length of end of life was significantly longer in the relatively well controlled patients (144 days; 95% CI 115.9-172.1) than in poorly controlled patients (45 days; 95% CI 13.8-76.2, P=0.02). Cox multivariate analysis indicated that performance status (PS) at the initial visit to the hospice (hazard ratio [HR] 2.79; 95% CI 1.46-5.32, P=0.002) and glycemic control (HR 2.10; 95% CI 1.18-3.75, P=0.01) were independent, positive prognostic factors. Good glycemic control, that is, maintenance of A1C levels at <7.5% during the terminal phase of cancer, conferred a significant survival benefit in cancer patients who had preexisting type 2 diabetes.