Insulin resistance in patients with cancer: a systematic review and meta-analysis

Joan M. Màrmol, Michala Carlsson, Steffen Henning Raun, Mia K Grand, Jonas Sørensen, Louise Lang Lehrskov, Erik A. Richter, Ole Norgaard, Lykke Sylow*

*Corresponding author for this work

Research output: Contribution to journalReviewResearchpeer-review

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Abstract

Background: Insulin resistance is a critical cause of metabolic dysfunctions. Metabolic dysfunction is common in patients with cancer and is associated with higher cancer recurrence rates and reduced overall survival. Yet, insulin resistance is rarely considered in the clinic and thus it is uncertain how frequently this condition occurs in patients with cancer.

Methods: To address this knowledge gap, we performed a systematic review and a meta-analysis guided by the Preferred Items for Systematic Review and Meta-Analyses (PRISMA) statement. We included studies assessing insulin resistance in patients with various cancer diagnoses, using the gold-standard hyperinsulinemic-euglycemic clamp method. Studies eligible for inclusion were as follows: (1) included cancer patients older than 18 years of age; (2) included an age-matched control group consisting of individuals without cancer or other types of neoplasms; (3) measured insulin sensitivity using the hyperinsulinemic-euglycemic clamp method. We searched the databases MEDLINE, Embase, and Cochrane Central Register of Controlled Trials for articles published from database inception through March 2023 with no language restriction, supplemented by backward and forward citation searching. Bias was assessed using funnel plot.

Findings: Fifteen studies satisfied the criteria. The mean insulin-stimulated rate of glucose disposal (Rd) was 7.5 mg/kg/min in control subjects (n = 154), and 4.7 mg/kg/min in patients with a cancer diagnosis (n = 187). Thus, the Rd mean difference was -2.61 mg/kg/min [95% confidence interval, -3.04; -2.19], p<.01). Heterogeneity among the included studies was insignificant (p=.24).

Interpretation: These findings suggest that patients with a cancer diagnosis are markedly insulin resistant. As metabolic dysfunction in patients with cancer associates with increased recurrence and reduced overall survival, future studies should address if ameliorating insulin resistance in this population can improve these outcomes thereby improving patient care.

Original languageEnglish
JournalActa Oncologica
Volume62
Issue number4
Pages (from-to)364-371
ISSN1100-1704
DOIs
Publication statusPublished - 2023

Keywords

  • Faculty of Science
  • Cancer
  • Insulin resistance
  • Metabolic dysfunction
  • Hyperinsulinemic-euglycemic clamp
  • Systematic review
  • Meta-analysis

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