Capecitabine-induced severe diabetes and hypokalemia: a case report

Neuroendocrine tumors and diabetes mellitus: which treatment and which effect

Diabetes mellitus (DM) and neuroendocrine tumors (NET) can exert unfavorable effects on each other prognosis. In this narrative review, we evaluated the effects of NET therapies on glycemic control and DM management and the effects of anti-diabetic therapies on NET outcome and management. For this purpose, we searched the PubMed, Science Direct, and Google Scholar databases for studies reporting the effects of NET therapy on DM as well as the effect of DM therapy on NET. The majority of NET treatments appear to impair glycaemic control, both inducing hypoglycemic or, more commonly, hyperglycemia and even new-onset DM. However, glucose metabolism imbalance can be effectively managed by modulating anti-diabetic therapy and adopting an appropriate nutritional approach. On the other hand, the effects of anti-diabetic treatment, like insulin, sulfonylureas, thiazolidinediones, ipeptidyl-peptidase-4 inhibitors, Glucagon-like peptide-1 receptor agonists, and Sodium-glucose cotransporter-2 inhibitors on NET are unclear. Recently, metformin has been investigated in patients with gastroenteropancreatic NET resulting in improved progression free survival suggesting a potential antineoplastic role. Finally, the management of DM in patients with NET is of great clinical relevance to correctly perform radiological procedures and even more functional imaging procedures, as well as to optimize the therapy and avoid treatment withdrawal or discontinuation. In conclusion, understanding the mechanisms underlying therapy-induced DM and implementing appropriate monitoring and management strategies of DM are essential for optimizing NET patient outcome and quality of life.

Colorectal Cancer and Subsequent Diabetes Risk: A Population-Based Cohort Study in Taiwan

CONTEXT

The association between colorectal cancer (CRC) and new-onset diabetes mellitus remains unclear.

OBJECTIVE

To examine the association between CRC and the risk of subsequent diabetes mellitus and to further investigate the impact of chemotherapy on diabetes mellitus risk in CRC.

METHODS

In this nationwide cohort study using the Taiwan Cancer Registry database (2007-2018) linked with health databases, 86 268 patients with CRC and an equal propensity score-matched cohort from the general population were enrolled. Among them, 37 277 CRC patients from the Taiwan Cancer Registry (2007-2016) were analyzed for diabetes mellitus risk associated with chemotherapy. Chemotherapy exposure within 3 years of diagnosis was categorized as no chemotherapy, < 90 days, 90 to 180 days, and > 180 days. Differences in diabetes mellitus risk were assessed across these categories.

RESULTS

Each group involved 86 268 participants after propensity score matching. The patients with CRC had a 14% higher risk of developing diabetes mellitus than the matched general population (hazard ratio [HR]: 1.14; 95% CI, 1.09-1.20). The highest risk was observed within the first year after diagnosis, followed by a sustained elevated risk. Long-term chemotherapy (> 180 days within 3 years) was associated with a 60% to 70% increased risk of subsequent diabetes mellitus (HR: 1.64; 95% CI, 1.07-2.49).

CONCLUSION

Patients with CRC are associated with an elevated risk of diabetes mellitus, and long-term chemotherapy, particularly involving capecitabine, increases diabetes mellitus risk. Thus, monitoring blood glucose levels is crucial for patients with CRC, especially during extended chemotherapy.

Prevalence and Related Factors of Hypokalemia in Patients with Acute Ischemic Stroke

Aim

This study aimed to investigate the prevalence and associated factors of hypokalemia in patients with acute ischemic stroke.

Methods

A cohort of 996 patients was assessed using a general data questionnaire, laboratory indicators, the NIH Stroke Scale (NIHSS), the Barthel Index (BI), the Frail scale, Nutritional Risk Screening (NRS-2002), and the Kubota drinking water test.

Results

Among the 996 patients, 205 (20.6%) were found to have hypokalemia. Logistic regression analysis identified several independent predictors of hypokalemia: age (OR 1.020, 95% CI 1.001-1.039, P=0.041), hypertension (OR 2.691, 95% CI 1.190-6.089, P=0.017), Frail score (OR 1.756, 95% CI 1.034-2.981, P=0.037), Kubota drinking water test grade 3 (OR 2.124, 95% CI 1.055-4.276, P=0.035), Kubota drinking water test grade 4 (OR 3.016, 95% CI 1.113-8.174, P=0.037), NIHSS score (OR 1.135, 95% CI 1.018-1.264, P=0.022), platelet count (OR 0.997, 95% CI 0.994-0.999, P=0.021), and urea nitrogen levels (OR 0.833, 95% CI 0.750-0.926, P=0.001).

Conclusion

The prevalence of hypokalemia is high in patients with acute ischemic stroke. Independent risk factors included age, hypertension, frailty, neurological function, swallowing function, platelet count and blood urea level.