The impact of ADT on diabetics who are also diagnosed with prostate cancer

It has long been understood that treatment of prostate cancer with androgen deprivation therapy (ADT) can both increase the risk for diabetes among non-diabetic patients and can decrease sensitivity to insulin among men with diabetes. What has been missing, however, are good data about how ADT affects diabetes control among men with diabetes.

A newly published study by Keating et al. — albeit based on administrative data from a cohort of patients as opposed to a patients enrolled in a prospective clinical trial — has offered some initial insight into this issue.

The research team looked at data from 2,237 matched pairs of men with prostate cancer and diabetes who either were or were not treated with ADT (with all data extracted from a U.S. Department of Veterans Affairs registry). Specifically, their goal was to assess the effects of ADT on diabetes control, as measured by clinical levels of hemoglobin A1c (HbA1c) — a standard metric for diabetes control — and the need for increased use of diabetes pharmacotherapy. For many diabetic patients, the goal is to keep the HbA1c level level at or below about 6.5 to 7.0 percent.

Here is what Keating et al. report:

  • Before any use of ADT, the average (mean) baseline levels of HbA1c were:
    • 7.24 ± 0.05 percent among subsequent ADT patients
    • 7.24 ± 0.04 percent among the non-ADT patients
  • After 1 year of ADT use by the ADT patients, the mean levels of HbA1c were:
    • 7.38 ± 0.04 percent among ADT patients
    • 7.14 ± 0.04 percent among the non-ADT patients
    • This “difference of differences” was +0.24, which was statistically significant (p = 0.008)
  • After 2 years of ADT use by the ADT patients, the results were similar and were still statistically significant (p = 0.03)
  • Over the time frame of the study, the ADT patients were more likely that the non-ADT patients to have increased use of diabetes medications (adjusted hazard ratio = 1.20).

Keating et al. conclude that, in this cohort of patients, “ADT is associated with worsening of diabetes control and increases in HbA1c levels despite the use of additional diabetes medications.”

The practical implications of this study are not entirely clear. It will be obvious that at least some diabetic patients who are diagnosed with prostate cancer (and some prostate cancer patients who are diagnosed with diabetes) do need both ADT and pharmacotherapy to manage their insulin levels. What is equally obvious to The “New” Prostate Cancer InfoLink, however, is that ADT needs to be applied with caution and attention to detail in men who are already diabetic, with close coordination of their care between the relevant caregivers (primary care physician, endocrinologist, and urologist or medical oncologist).

One Response

  1. Zoladex gave me diabetes amongst other serious side effects. I stopped after one 3-month injection and feel fine but still have diabetes.

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