Insulin resistance in patients with cancer: a systematic review and meta-analysis
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Insulin resistance in patients with cancer: a systematic review and meta-analysis. / Màrmol, Joan M.; Carlsson, Michala; Raun, Steffen Henning; Grand, Mia K; Sørensen, Jonas; Lang Lehrskov, Louise; Richter, Erik A.; Norgaard, Ole; Sylow, Lykke.
In: Acta Oncologica, Vol. 62, No. 4, 2023, p. 364-371.Research output: Contribution to journal › Review › Research › peer-review
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TY - JOUR
T1 - Insulin resistance in patients with cancer: a systematic review and meta-analysis
AU - Màrmol, Joan M.
AU - Carlsson, Michala
AU - Raun, Steffen Henning
AU - Grand, Mia K
AU - Sørensen, Jonas
AU - Lang Lehrskov, Louise
AU - Richter, Erik A.
AU - Norgaard, Ole
AU - Sylow, Lykke
N1 - CURIS 2023 NEXS 088
PY - 2023
Y1 - 2023
N2 - Background: Insulin resistance is a critical cause of metabolic dysfunctions. Metabolic dysfunction is common in patients with cancer and is associated with higher cancer recurrence rates and reduced overall survival. Yet, insulin resistance is rarely considered in the clinic and thus it is uncertain how frequently this condition occurs in patients with cancer.Methods: To address this knowledge gap, we performed a systematic review and a meta-analysis guided by the Preferred Items for Systematic Review and Meta-Analyses (PRISMA) statement. We included studies assessing insulin resistance in patients with various cancer diagnoses, using the gold-standard hyperinsulinemic-euglycemic clamp method. Studies eligible for inclusion were as follows: (1) included cancer patients older than 18 years of age; (2) included an age-matched control group consisting of individuals without cancer or other types of neoplasms; (3) measured insulin sensitivity using the hyperinsulinemic-euglycemic clamp method. We searched the databases MEDLINE, Embase, and Cochrane Central Register of Controlled Trials for articles published from database inception through March 2023 with no language restriction, supplemented by backward and forward citation searching. Bias was assessed using funnel plot.Findings: Fifteen studies satisfied the criteria. The mean insulin-stimulated rate of glucose disposal (Rd) was 7.5 mg/kg/min in control subjects (n = 154), and 4.7 mg/kg/min in patients with a cancer diagnosis (n = 187). Thus, the Rd mean difference was -2.61 mg/kg/min [95% confidence interval, -3.04; -2.19], p<.01). Heterogeneity among the included studies was insignificant (p=.24).Interpretation: These findings suggest that patients with a cancer diagnosis are markedly insulin resistant. As metabolic dysfunction in patients with cancer associates with increased recurrence and reduced overall survival, future studies should address if ameliorating insulin resistance in this population can improve these outcomes thereby improving patient care.
AB - Background: Insulin resistance is a critical cause of metabolic dysfunctions. Metabolic dysfunction is common in patients with cancer and is associated with higher cancer recurrence rates and reduced overall survival. Yet, insulin resistance is rarely considered in the clinic and thus it is uncertain how frequently this condition occurs in patients with cancer.Methods: To address this knowledge gap, we performed a systematic review and a meta-analysis guided by the Preferred Items for Systematic Review and Meta-Analyses (PRISMA) statement. We included studies assessing insulin resistance in patients with various cancer diagnoses, using the gold-standard hyperinsulinemic-euglycemic clamp method. Studies eligible for inclusion were as follows: (1) included cancer patients older than 18 years of age; (2) included an age-matched control group consisting of individuals without cancer or other types of neoplasms; (3) measured insulin sensitivity using the hyperinsulinemic-euglycemic clamp method. We searched the databases MEDLINE, Embase, and Cochrane Central Register of Controlled Trials for articles published from database inception through March 2023 with no language restriction, supplemented by backward and forward citation searching. Bias was assessed using funnel plot.Findings: Fifteen studies satisfied the criteria. The mean insulin-stimulated rate of glucose disposal (Rd) was 7.5 mg/kg/min in control subjects (n = 154), and 4.7 mg/kg/min in patients with a cancer diagnosis (n = 187). Thus, the Rd mean difference was -2.61 mg/kg/min [95% confidence interval, -3.04; -2.19], p<.01). Heterogeneity among the included studies was insignificant (p=.24).Interpretation: These findings suggest that patients with a cancer diagnosis are markedly insulin resistant. As metabolic dysfunction in patients with cancer associates with increased recurrence and reduced overall survival, future studies should address if ameliorating insulin resistance in this population can improve these outcomes thereby improving patient care.
KW - Faculty of Science
KW - Cancer
KW - Insulin resistance
KW - Metabolic dysfunction
KW - Hyperinsulinemic-euglycemic clamp
KW - Systematic review
KW - Meta-analysis
U2 - 10.1080/0284186X.2023.2197124
DO - 10.1080/0284186X.2023.2197124
M3 - Review
C2 - 37042166
VL - 62
SP - 364
EP - 371
JO - Acta Oncologica
JF - Acta Oncologica
SN - 1100-1704
IS - 4
ER -
ID: 342563211