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Obi MF, Namireddy V, Sharma M, Cho HJ, Udoyeh C, Morón Mercado LC, Htut Hann H. An Unfortunate Miss of Undiagnosed Arterial Ischemic Stroke (AIS) in the Setting of Diabetic Ketoacidosis in an Adult: A Case Report. Cureus 2023; 15:e38921. [PMID: 37313099 PMCID: PMC10259729 DOI: 10.7759/cureus.38921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2023] [Indexed: 06/15/2023] Open
Abstract
We present the case of a 43-year-old male with a history of poorly controlled type II diabetes who presented with altered mental status, urinary incontinence, and diabetic ketoacidosis (DKA). Initial brain imaging studies were negative for acute intracranial pathology; however, the next day, the patient was found to have left-sided paralysis. Repeat imaging studies revealed a right middle cerebral artery infarct with hemorrhagic conversion. Given that the rate of reported strokes in the setting of DKA in adults is limited, this case report affirms to discuss the importance of prompt recognition, evaluation, and adequate treatment of DKA to prevent neurological complications, as well as the pathophysiology behind the etiology of DKA-induced stroke. This case also underscores the importance of early recognition and missed strokes in the emergency department (ED) and emphasizes the need for stroke evaluation in patients with altered mental status even though an alternative diagnosis is apparent to avoid anchor bias.
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Affiliation(s)
- Mukosolu F Obi
- Internal Medicine, Wyckoff Heights Medical Center, Brooklyn, USA
| | | | - Manjari Sharma
- Internal Medicine, Wyckoff Heights Medical Center, Brooklyn, USA
| | - Hyun Joon Cho
- Internal Medicine, Wyckoff Heights Medical Center, Brooklyn, USA
| | - Chidimma Udoyeh
- Medicine, St. George's University School of Medicine, True Blue, GRD
| | | | - Haymar Htut Hann
- Internal Medicine, Wyckoff Heights Medical Center, Brooklyn, USA
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Kabir MT, Ferdous Mitu J, Akter R, Akhtar MF, Saleem A, Al-Harrasi A, Bhatia S, Rahman MS, Damiri F, Berrada M, Rahman MH. Therapeutic potential of dopamine agonists in the treatment of type 2 diabetes mellitus. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:46385-46404. [PMID: 35486279 DOI: 10.1007/s11356-022-20445-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 04/21/2022] [Indexed: 06/14/2023]
Abstract
Diabetes is a global health concern that has affected almost 415 million people globally. Bromocriptine is a dopamine D2 agonist, which is a Food and Drug Administration (FDA)-approved drug to treat type 2 diabetes mellitus (T2DM) patients. However, it is considered that a novel treatment therapy is required which can be used in the treatment of diabetes with or without other antidiabetic agents. Dopamine agonists are usually used in neurological disorders like Parkinson's disease (PD), restless leg syndrome, and hyperprolactinemia. However, dopamine agonists including bromocriptine and cabergoline are also effective in reducing the glycemic level in T2DM patients. Bromocriptine was formerly used for the treatment of PD, hyperprolactinemia, and restless leg syndrome, but now it is used for improving glycemic levels as well as reducing free fatty acids and triglycerides. In addition, cabergoline has been found to be effective in glycemic control, but this drug is yet to be approved by the FDA due to its limitations and lack of study. Findings of the clinical trials of bromocriptine have suggested that it reduces almost 0.4-0.8% glycated hemoglobin and cardiovascular risk by 40% in insulin-resistant patients. Moreover, the safe use of bromocriptine in obese T2DM patients makes it a more attractive option as it causes weight loss. Indeed, bromocriptine is a novel therapy for T2DM patients, as its mechanism of action is unique in T2DM patients with minimal adverse effects. This review summarizes the potential of dopamine agonists in the treatment of T2DM.
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Affiliation(s)
- Md Tanvir Kabir
- Department of Pharmacy, Brac University, 66 Mohakhali, Dhaka, 1212, Bangladesh
| | | | - Raushanara Akter
- Department of Pharmacy, Brac University, 66 Mohakhali, Dhaka, 1212, Bangladesh
| | - Muhammad Furqan Akhtar
- Riphah Institute of Pharmaceutical Sciences, Riphah International University Lahore Campus, Lahore, Pakistan
| | - Ammara Saleem
- Department of Pharmacology, Faculty of Pharmaceutical Sciences, Government College University Faisalabad, Faisalabad, Pakistan
| | - Ahmed Al-Harrasi
- Natural & Medical Sciences Research Center, University of Nizwa, 616 Birkat Al Mauz, P.O. Box 33, Nizwa, Oman
| | - Saurabh Bhatia
- Natural & Medical Sciences Research Center, University of Nizwa, 616 Birkat Al Mauz, P.O. Box 33, Nizwa, Oman
- School of Health Science, University of Petroleum and Energy Studies, Prem Nagar, Dehradun, Uttarakhand, 248007, India
| | - Md Sohanur Rahman
- Department of Biochemistry and Molecular Biology, Trust University, Barishal, Ruiya, Nobogram Road, Barishal, 8200, Bangladesh
| | - Fouad Damiri
- Laboratory of Biomolecules and Organic Synthesis (BIOSYNTHO), Department of Chemistry, Faculty of Sciences Ben M'Sick, University Hassan II of Casablanca, Casablanca, Morocco
| | - Mohammed Berrada
- Laboratory of Biomolecules and Organic Synthesis (BIOSYNTHO), Department of Chemistry, Faculty of Sciences Ben M'Sick, University Hassan II of Casablanca, Casablanca, Morocco
| | - Md Habibur Rahman
- Department of Pharmacy, Southeast University, Banani, Dhaka, 1213, Bangladesh.
- Department of Global Medical Science, Wonju College of Medicine, Yonsei University, Wonju, 26426, Gangwon-do, Korea.
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3
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Shahid RK, Ahmed S, Le D, Yadav S. Diabetes and Cancer: Risk, Challenges, Management and Outcomes. Cancers (Basel) 2021; 13:5735. [PMID: 34830886 PMCID: PMC8616213 DOI: 10.3390/cancers13225735] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 11/03/2021] [Accepted: 11/12/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Diabetes mellitus and cancer are commonly coexisting illnesses, and the global incidence and prevalence of both are rising. Cancer patients with diabetes face unique challenges. This review highlights the relationship between diabetes and cancer and various aspects of the management of diabetes in cancer patients. METHODS A literature search using keywords in PubMed was performed. Studies that were published in English prior to July 2021 were assessed and an overview of epidemiology, cancer risk, outcomes, treatment-related hyperglycemia and management of diabetes in cancer patients is provided. RESULTS Overall, 8-18% of cancer patients have diabetes as a comorbid medical condition. Diabetes is a risk factor for certain solid malignancies, such as pancreatic, liver, colon, breast, and endometrial cancer. Several novel targeted compounds and immunotherapies can cause hyperglycemia. Nevertheless, most patients undergoing cancer therapy can be managed with an appropriate glucose lowering agent without the need for discontinuation of cancer treatment. Evidence suggests that cancer patients with diabetes have higher cancer-related mortality; therefore, a multidisciplinary approach is important in the management of patients with diabetes and cancer for a better outcome. CONCLUSIONS Future studies are required to better understand the underlying mechanism between the risk of cancer and diabetes. Furthermore, high-quality prospective studies evaluating management of diabetes in cancer patients using innovative tools are needed. A patient-centered approach is important in cancer patients with diabetes to avoid adverse outcomes.
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Affiliation(s)
- Rabia K. Shahid
- Department of Medicine, University of Saskatchewan, Saskatoon, SK S7N 5A2, Canada;
| | - Shahid Ahmed
- Saskatoon Cancer Center, Saskatchewan Cancer Agency, University of Saskatchewan, Saskatoon, SK S7N 4H4, Canada; (D.L.); (S.Y.)
| | - Duc Le
- Saskatoon Cancer Center, Saskatchewan Cancer Agency, University of Saskatchewan, Saskatoon, SK S7N 4H4, Canada; (D.L.); (S.Y.)
| | - Sunil Yadav
- Saskatoon Cancer Center, Saskatchewan Cancer Agency, University of Saskatchewan, Saskatoon, SK S7N 4H4, Canada; (D.L.); (S.Y.)
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Ćirić V. https://publisher.medfak.ni.ac.rs/AMM_1/2019/2019-1-broj/Abs_eng/18Mike%20Barbeck.pdf. ACTA MEDICA MEDIANAE 2019. [DOI: 10.5633/amm.2019.0111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Aung ET, Koshy RM, Jacob K. Diabetic ketoacidosis in a patient with type 2 diabetes precipitated by infection, steroids and SGLT2 inhibitor. PRACTICAL DIABETES 2019. [DOI: 10.1002/pdi.2217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Markabawi D, Kondapi D, Tambe V, Seth R. When it is not just DKA; diabetic ketoacidosis as a first presentation of pancreatic adenocarcinoma. Am J Emerg Med 2018; 36:1720.e1-1720.e2. [DOI: 10.1016/j.ajem.2018.05.070] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 05/29/2018] [Indexed: 11/25/2022] Open
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Tiwari A, Al-Robeh H, Sharma H, Ammari Z, Khan MS, Jaume JC. Steroid-Induced Diabetic Ketoacidosis in a Patient with Type 2 Diabetes Mellitus. AACE Clin Case Rep 2018. [DOI: 10.4158/ep171984.cr] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Kaya T, Korkmaz S, Vargol E, Karacan A, Cinemre H. Diabetic ketoacidosis as the presenting manifestation of pancreatic adenocarcinoma with cystic features. Turk J Emerg Med 2017; 17:4-6. [PMID: 28345065 PMCID: PMC5357086 DOI: 10.1016/j.tjem.2016.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 05/17/2016] [Indexed: 01/22/2023] Open
Abstract
The common presenting symptoms of pancreatic cancer are abdominal pain, weight loss, and jaundice. Pancreatic adenocarcinoma presenting with diabetic ketoacidosis is a very rare emergent clinical condition. However, pancreatic ductal cystadenocarcinoma presenting with diabetic ketoacidosis was not reported. We describe a 60-year-old man with pancreatic cystadenocarcinoma presenting with diabetic ketoacidosis as the initial manifestation. It must be kept in mind that in diabetic ketoacidosis cases, the precipitating factor may be pancreatic ductal cystadenocarcinoma.
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Affiliation(s)
- Tezcan Kaya
- Department of Internal Medicine, Sakarya University Faculty of Medicine, Sakarya, Turkey
| | - Sumeyye Korkmaz
- Department of Internal Medicine, Sakarya University Faculty of Medicine, Sakarya, Turkey
| | - Erdem Vargol
- Department of Pathology, Sakarya University Training and Research Hospital, Sakarya, Turkey
| | - Alper Karacan
- Department of Radiology, Sakarya University Faculty of Medicine, Sakarya, Turkey
| | - Hakan Cinemre
- Department of Internal Medicine, Sakarya University Faculty of Medicine, Sakarya, Turkey
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Kum-Nji JS, Gosmanov AR, Steinberg H, Dagogo-Jack S. Hyperglycemic, high anion-gap metabolic acidosis in patients receiving SGLT-2 inhibitors for diabetes management. J Diabetes Complications 2017; 31:611-614. [PMID: 27913012 DOI: 10.1016/j.jdiacomp.2016.11.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 10/21/2016] [Accepted: 11/04/2016] [Indexed: 11/21/2022]
Abstract
Sodium-glucose cotransporter-2 inhibitors (SGLT-2i) are a class of antidiabetic medications that improve glycemic control via inhibiting the reabsorption of filtered glucose and are approved for use in type 2 diabetes (T2DM). These drugs have recently been associated with euglycemic diabetic ketoacidosis (DKA). An increasing number of cases of SGLT-2i-associated DKA have occurred in patients with T2DM. Herein, we describe five episodes of hyperglycemic DKA in four type 2 diabetes patients receiving SGLT-2i therapy. Risk for ketoacidosis in our case series was mediated predominately by reduction of insulin dose and insulinopenia. None of the patients reported a history of low carbohydrate diet or alcohol use, and all but one patient had negative glutamic acid decarboxylase antibodies. Resolution of DKA in SGLT-2i treated patients took longer than for T1DM patients with DKA based on literature data. The mechanisms by which SGLT-2i are associated with ketoacidosis are not fully understood and likely involve hyperglucagonemia and other factors. Further studies are needed to elucidate the precise mechanism.
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Affiliation(s)
- Juliette Sandifer Kum-Nji
- Department of Medicine, Division of Endocrinology, Diabetes & Metabolism, University of Tennessee Health Science Center, Memphis, TN
| | | | - Helmut Steinberg
- Department of Medicine, Division of Endocrinology, Diabetes & Metabolism, University of Tennessee Health Science Center, Memphis, TN
| | - Samuel Dagogo-Jack
- Department of Medicine, Division of Endocrinology, Diabetes & Metabolism, University of Tennessee Health Science Center, Memphis, TN.
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Zhong G, Cross R. Pancreatic adenocarcinoma presenting as first-onset diabetic ketoacidosis. Med J Aust 2015; 202:444-5. [PMID: 25929509 DOI: 10.5694/mja14.01594] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 02/12/2015] [Indexed: 11/17/2022]
Affiliation(s)
- George Zhong
- Concord Repatriation General Hospital, Sydney, NSW, Australia.
| | - Rosalba Cross
- Concord Repatriation General Hospital, Sydney, NSW, Australia
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Cuyàs E, Corominas-Faja B, Menendez JA. The nutritional phenome of EMT-induced cancer stem-like cells. Oncotarget 2015; 5:3970-82. [PMID: 24994116 PMCID: PMC4147299 DOI: 10.18632/oncotarget.2147] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
The metabolic features of cancer stem (CS) cells and the effects of specific nutrients or metabolites on CS cells remain mostly unexplored. A preliminary study to delineate the nutritional phenome of CS cells exploited the landmark observation that upon experimental induction into an epithelial-to-mesenchymal (EMT) transition, the proportion of CS-like cells drastically increases within a breast cancer cell population. EMT-induced CS-like cells (HMLERshEcad) and isogenic parental cells (HMLERshCntrol) were simultaneously screened for their ability to generate energy-rich NADH when cultured in a standardized high-throughput metabolic phenotyping platform comprising >350 wells that were pre-loaded with different carbohydrates/starches, alcohols, fatty acids, ketones, carboxylic acids, amino acids, and bi-amino acids. The generation of “phenetic maps” of the carbon and nitrogen utilization patterns revealed that the acquisition of a CS-like cellular state provided an enhanced ability to utilize additional catabolic fuels, especially under starvation conditions. Crucially, the acquisition of cancer stemness activated a metabolic infrastructure that enabled the vectorial transfer of high-energy nutrients such as glycolysis end products (pyruvate, lactate) and bona fide ketone bodies (β-hydroxybutyrate) from the extracellular microenvironment to support mitochondrial energy production in CS-like cells. Metabolic reprogramming may thus constitute an efficient adaptive strategy through which CS-like cells would rapidly obtain an advantage in hostile conditions such as nutrient starvation following the inhibition of tumor angiogenesis. By understanding how specific nutrients could bioenergetically boost EMT-CS-like phenotypes, “smart foods” or systemic “metabolic nichotherapies” may be tailored to specific nutritional CSC phenomes, whereas high-resolution heavy isotope-labeled nutrient tracking may be developed to monitor the spatiotemporal distribution and functionality of CS-like cells in real time.
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Affiliation(s)
- Elisabet Cuyàs
- Metabolism & Cancer Group, Translational Research Laboratory, Catalan Institute of Oncology, Girona, Catalonia, SPAIN; Girona Biomedical Research Institute (IDIBGI), Girona, Catalonia, SPAIN
| | - Bruna Corominas-Faja
- Metabolism & Cancer Group, Translational Research Laboratory, Catalan Institute of Oncology, Girona, Catalonia, SPAIN; Girona Biomedical Research Institute (IDIBGI), Girona, Catalonia, SPAIN
| | - Javier A Menendez
- Metabolism & Cancer Group, Translational Research Laboratory, Catalan Institute of Oncology, Girona, Catalonia, SPAIN; Girona Biomedical Research Institute (IDIBGI), Girona, Catalonia, SPAIN
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12
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Puttanna A, Padinjakara RNK. Diabetic ketoacidosis in type 2 diabetes mellitus. PRACTICAL DIABETES 2014. [DOI: 10.1002/pdi.1852] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- A Puttanna
- Department of Diabetes and Endocrinology; Walsall Hospitals NHS Healthcare Trust; Walsall UK
| | - RNK Padinjakara
- Department of Diabetes and Endocrinology; Walsall Hospitals NHS Healthcare Trust; Walsall UK
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13
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Lee KA, Park KT, Kim WJ, Park TS, Baek HS, Jin HY. Diabetic ketoacidosis as a presenting symptom of complicated pancreatic cancer. Korean J Intern Med 2014; 29:116-9. [PMID: 24574842 PMCID: PMC3932382 DOI: 10.3904/kjim.2014.29.1.116] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2013] [Revised: 04/18/2013] [Accepted: 07/05/2013] [Indexed: 12/03/2022] Open
Affiliation(s)
- Kyung Ae Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Research Institute of Clinical Medicine, Chonbuk National University Hospital, Jeonju, Korea
| | - Kyung Taek Park
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeolin Hospital, Jeonju, Korea
| | - Woong Ji Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Jeonju Hospital, Jeonju, Korea
| | - Tae Sun Park
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Research Institute of Clinical Medicine, Chonbuk National University Hospital, Jeonju, Korea
| | - Hong Sun Baek
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Research Institute of Clinical Medicine, Chonbuk National University Hospital, Jeonju, Korea
| | - Heung Yong Jin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Research Institute of Clinical Medicine, Chonbuk National University Hospital, Jeonju, Korea
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14
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Abstract
Ketone bodies are produced in the liver and are utilized in other tissues in the body as an energy source when hypoglycemia occurs in the body. There are three ketone bodies: acetoacetate, beta hydroxy butyrate, and acetone. Ketone bodies are usually present in the blood, and their level increases during fasting and starvation. They are also found in the blood of neonates and pregnant women. In diabetic ketoacidosis, high levels of ketone bodies are produced in response to low insulin levels and high levels of counter-regulatory hormones.
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Affiliation(s)
- Muhammad Akram
- Department of Eastern Medicine and Surgery, Faculty of Medical and Health Sciences, The University of Poonch , Rawalakot, Azad Jammu and Kashmir, Pakistan
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Li J, Cao G, Ma Q, Liu H, Li W, Han L. The bidirectional interation between pancreatic cancer and diabetes. World J Surg Oncol 2012; 10:171. [PMID: 22920886 PMCID: PMC3499274 DOI: 10.1186/1477-7819-10-171] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2012] [Accepted: 08/11/2012] [Indexed: 12/15/2022] Open
Abstract
The bidirectional interation between pancreatic cancer (PanCa) and diabetes has been confirmed by epidemiological studies, which provide evidence-based medical support for further research into the mechanisms involved in the interaction. We reviewed the literature regarding the role of diabetes in the generation and progression of PanCa and the mechanism by which PanCa induces diabetes for its malignant progression. The effect of antidiabetic drugs on the occurrence and prognosis of PanCa was also reviewed. Diabetes may directly promote the progression of PanCa by pancreatic duct enlargement and hypertension, as well as by enabling an increased tumor volume. Hyperinsulinemia, insulin resistance, cytokines, hyperglycemia and genotype change are also important factors in the progression of PanCa with diabetes. Hyperglycemia may be the first clinical manifestation and is helpful in the early diagnosis of PanCa. Furthermore, antidiabetic drugs can have different effects on the occurrence and prognosis of PanCa. The bidirectional interation between PanCa and diabetes is involved in the occurrence, proliferation, invasion, metastasis and prognosis of PanCa with diabetes. The discovery of biomarkers for the early diagnosis of PanCa, as well as the novel usage of metformin for its antitumor effects and determining the potential mechanisms of these effects, may be the next direction for PanCa research and treatment.
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Affiliation(s)
- Junhui Li
- Department of General Surgery, Second Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, 157 West 5th Road, Xi'an 710004, People's Republic of China
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Watanabe M, Matsumoto H, Tomiyama C, Akazawa K, Abo T. Internal environment for growth of cancer cells in mice: hypothermia, anemia and lymphocytopenia. Health (London) 2011. [DOI: 10.4236/health.2011.34042] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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