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Panminerva Medica 2003 June;45(2):133-43


lingua: Inglese

High rate of neoplasia and other co-morbid conditions in type-2 diabetic patients with longer duration of disease and poor metabolic control

Jarmuzewska E. A. 1, Cerri C. 2, Ghidoni A. 1, Mangoni A. A. 3

1 Department of Internal Medicine, IRCCS Polyclinic, University of Milan, Milan, Italy 2 Neurophysiology Unit, University of Milan, Bicocca, Milan, Italy 3 Department of Health Care of the Elderly, Guy’s, King’s, and St Thomas’ School of Medicine, King’s College London, London, UK


Aim. The aim of the ­study was to ­assess the ­rate of neu­ro­en­do­crine malig­nan­cies in the gas­troin­tes­ti­nal ­tract, oth­er malig­nan­cies and mitot­ic pro­cess­es, in ­type-2 dia­bet­ic ­patients. In par­tic­u­lar, we test­ed the hypoth­e­sis ­that a ­poor meta­bol­ic con­trol is asso­ciat­ed ­with a high­er ­rate of neo­plasms and oth­er co-mor­bid con­di­tions, ­such as hyper­ten­sion and periph­er­al neu­rop­a­thy.
Methods. Forty-one con­sec­u­tive asymp­to­mat­ic ­type-2 dia­bet­ic out­pa­tients ­were fol­lowed for 8 ­years and clus­tered in 2 ­groups, accord­ing to dis­ease dura­tion, insu­lin ­need, and ­dose of ­oral anti­di­a­bet­ic ­agents. Physical exam­ina­tion, ­blood pres­sure meas­ure­ments, and neu­ro­phys­io­log­ic stud­ies ­were seri­al­ly per­formed dur­ing the fol­low-up. In ­each sub­ject, a gen­er­al bio­chem­is­try was per­formed, aspe­cif­ic and spe­cif­ic anti­gens (α-fet­o­pro­tein, car­ci­noem­brion­ic-anti­gen and pros­tate spe­cif­ic anti­gen PSA and F-PSA) lev­els ­were meas­ured, and inva­sive and non-inva­sive pro­ce­dures ­were car­ried out, ­when nec­es­sary, to ­detect a neo­plas­tic pro­cess.
Results. The ­rate of malig­nan­cies and mitot­ic pro­cess­es was sig­nif­i­cant­ly high­er in ­patients ­with long­er dura­tion of dis­ease and ­poor dia­betes con­trol (72% vs 13%, p=0.02). Hyperten­sion (83% vs 54%) and periph­er­al neu­rop­a­thy (67% vs 21%) ­were ­also ­more com­mon in ­this ­group.
Conclusion. These ­data, ­although ­obtained in a rel­a­tive­ly ­small pop­u­la­tion, high­light the impor­tance of close­ly mon­i­tor­ing ­type-2 dia­bet­ic ­patients ­with ­poor dia­betes con­trol as ­this ­might be asso­ciat­ed ­with the pres­ence of malig­nan­cy or oth­er co-mor­bid con­di­tions. This may be par­tic­u­lar­ly ­true ­when the ­poor gly­cem­ic con­trol is char­ac­ter­ised by a sud­den ­onset or sig­nif­i­cant wors­en­ing ­despite streght­en­ing of anti­di­a­bet­ic ther­a­py.

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