METHODS: The systematic review was conducted from April to September 2022, and comprised search on PubMed, Web of Sciences, Scopus, Science Direct and Google Scholar databases for relevant studies published in English language between January 1, 2000, and June 30, 2022. The search was updated in September 2022. After transferring literature to Mendeley, relevant data was extracted from the included studies. Quality assessment for eligible studies was done using Joanna Briggs Institute Critical Appraisal Checklist. Quality of evidences was assessed by using Grading of Recommendations Assessment, Development and Evaluation tool.
RESULTS: Of the 203 studies identified, 18(8.9%) were analysed; 16(89%) with humans and 2(11%) with animals as subjects There were 5 (31.25%) studies for SP-D, of which 4 (80%) studies reported lower surfactant protein-D in type 2 diabetes mellitus cases than controls. Its significant negative association with glycated haemoglobin was reported by 1(20%) study and 2(40%) studies with fasting blood glucose levels. Higher surfactant protein-D in type 2 diabetes mellitus cases and its positive association with glycated haemoglobin was reported by 1(20%) study. Recurrent infections were frequent in type 2 diabetes mellitus patients. Malondialdehyde level was higher and superoxide dismutase activity was lower in type 2 diabetes mellitus cases, reflecting oxidative stress. Animal studies also showed that reactive oxygen species generating from hypochlorous acid during oxidative stress promoted the formation of non-disulfide linkages in surfactant protein-D structure, resulting in its decreased functionality.
CONCLUSION: Surfactant protein-D, oxidative stress, inflammation and infections were found to be linked to each other for pathogenesis of infections in type 2 diabetes mellitus.
METHOD: This case-control study was conducted at Aziz Fatimah Hospital and Aziz Fatimah Medical and Dental College, Faisalabad, Pakistan, from May 2023 to January 2024. A total of 170 subjects were included in the study through purposive sampling technique. Fasting and random blood glucose levels were measured using an enzymatic colorimetric test. HbA1c was determined with the Bioherms A1C EZ 2.0 Glyco-hemoglobin Test Kit. QOL was assessed using the Short Form-36 version 1 questionnaire. Statistical analysis was performed using SPSS version 26, with p ≤ 0.05 considered significant.
RESULTS: The study included 86 T2DM patients and 84 controls, with a mean age of 49.23 ± 12.59 years. Among the participants, 44.7% were male and 55.3% were female. T2DM patients scored lower in physical functioning, limitations due to physical health, bodily pain and vitality subscale compared to controls (p = 0.003, 0.050, 0.030, 0.000 respectively). Both groups had physical component summary and mental component summary (MCS) scores below 50, indicating impaired QOL. MCS scores were significantly lower in T2DM patients than in controls (p = 0.002). Females scored lower in vitality (p = 0.0005) and bodily pain (p = 0.031). T2DM patients with less than five years of duration had lower SF-36 scores than those with longer duration.
CONCLUSION: T2DM impairs quality of life, especially in females and those with less than five years of disease duration, who face a greater negative impact.
METHODS: Medical records of breast cancer women with T2DM who received NACT from January 2016 to January 2021 at the medical center in the Gujranwala Institute of Nuclear Medicine and Radiotherapy, Pakistan, were identified and retrieved retrospectively. Variables, including pathological responses, diabetes status, and other clinical data, were collected. Patients were grouped as diabetic and nondiabetic based on the doctor's diagnosis or the diabetic's medication history recorded upon the breast cancer diagnosis. Factors influencing the pathological complete response (pCR) were determined using multivariate logistic regression utilizing IBM SPSS Statistics (version 20).
RESULTS: A total of 1372 patient files who received NACT and breast cancer surgery from January 2016 to January 2021 were selected. Out of 1372 breast cancer women receiving NACT, 345 (25.1%) had pre-existing diabetes, while 1027 (74.85%) were without pre-existing diabetes. The most common molecular subtypes of breast cancer were luminal A and B. Two hundred fifty-eight patients (18.8%) had a pCR after receiving NACT. The pCR in diabetic patients was 3.9%, and in nondiabetes, 14.9%. Most women had a pathological partial response (pPR) after the NACT 672 (48.9%). The pPR in diabetic patients was 11.0%, and in nondiabetic patients, it was 38.0%. In nondiabetics, the odds of achieving pPR increase more than pathological no response after the NACT with odd ratio: 1.71 (95% confidence interval: 1.24-2.37). The probability of pCR in patients with luminal B was 1.67 times higher than that in patients with triple-negative breast cancer with odd ratio: 1.67, 95% confidence interval (1.00-2.79), P = 0.05.
CONCLUSIONS: The results of the study show that T2DM may have an adverse impact on pCR and pPR following NACT and surgery. Further investigation is needed to explore how changes in blood glucose levels over time impact pathological responses.
PURPOSE: To determine the impact of dynamic changes in blood glucose during neo-adjuvant chemotherapy on the pathological responses in women with breast cancer, with and without concomitant diabetes.
METHOD: This prospective cohort study was conducted among women with locally advanced breast cancer receiving treatment at GINUM Hospital in Gujranwala, Pakistan. Data for the prospective phase were collected from 20 January 2023 to-13 May 2024. Clinical data were obtained using a structured data collection form. Diabetes status was confirmed at baseline using Glycated hemoglobin (HbA1c) and Fasting blood glucose (FBG) tests. Patients were classified into glycemic trajectories based on the values of their FBG values during the treatment period.
RESULTS: Five blood glucose trajectories were identified from the start of breast cancer treatment to the post-treatment period: normal glycemic trajectory (23 patients, 4.1%), erratic glycemic trajectory (130 patients, 23.2%), consistently hyperglycemic trajectory (127 patients, 22.7%), controlled diabetes (130 patients, 23.2%), and uncontrolled diabetes (150 patients, 26.8%). All glycemic trajectory groups demonstrated a non-significant increase in the odds of achieving Pathological partial response (pPR). Similar to pPR, the various categories of blood glucose trajectories were associated with a non-significant increase in the odds of Pathological no response (pNR). Among nondiabetic patients the group I(normal) and group III (consistently hyperglycemic) trajectories showed no significant interaction with pathological responses, as indicated by repeated measures ANOVA.
CONCLUSION: Our findings indicated that fluctuations in FBG levels among individuals with diabetes were not associated with pathological responses to neo-adjuvant chemotherapy. This suggests that the rise in blood glucose levels in diabetic patients are more likely driven by their pre-existing metabolic dysfunction rather than their chemotherapy related pathological responses.