| Background and objectiveBreast cancer is the most common cancer among women. Recently, the incidence of breast cancer has increased yearly as the environment and lifestyle change and it has become a major life-threatening neoplastic disease for women. Similarly, in line with changing lifestyles, the incidence of diabetes and impaired glucose regulation gradually increases, and about 10% of patients with abnormal glucose tolerance develop into type 2 diabetes each year. Studies have found that cancer patients receiving chemotherapy have the higher incidence of impaired glucose regulation and diabetes than the normal population, and the occurrence rate of chemotherapy patients with impaired glucose regulation develop into type 2 diabetes disease increase rapidly. Therefore, it is especially important to investigate how to intervene in patients with impaired glucose regulation to reduce the incidence of diabetes.Impaired glucose regulation(IGR), also known as pre-diabetes, is a stage between normal metabolism and diabetes, including impaired fasting glucose(IFG), impaired glucose tolerance(IGT) and the merger of IFG and IGT. Epidemiological studies have found that the domestic development of IGT for diabetes in transformation rate is about 2 ~ 14%, IGR, the intermediary metabolism, is a special stage with the only reversibility to normal glucose tolerance(NGT); One study showed that domestic investigation in 346 Beijing shougang workers 30 ~ 64- year-old patients with IGT, two years later in 148 patients(42.8%) into a normal glucose tolerance, so the intervention in impaired glucose regulation(IGR) is an important stage to prevent type 2 diabetes mellitus(DM). There have been some prospective researches(2~10 years ranging) showing that lifestyle changes can reduce 30% ~50% incidence of DM, but it's more difficult to adhere for a long term and has less intervention; It also has been found that insulin intervention in patients with impaired glucose tolerance during chemotherapy, can reduce the incidence of diabetes; the intervention of Acarbose and metformin drugs in IGR patients during general population can reduce the incidence of diabetes. There have been some prospective researches(2~10 years ranging) show lifestyle changes can reduce 30%~50% incidence of DM, but more difficult to adhere to long-term, less intervention; The literature also found that insulin intervention in cancer chemotherapy in patients with impaired glucose tolerance, can reduce the incidence of diabetes; Acarbose and metformin drug intervention IGR patients in the general population, can reduce the incidence of diabetes. Metformin has a direct role in sugar metabolism, not by stimulating insulin ? cells but by increasing blood glucose lowering effect of insulin levels play, and plays a protective role in already damaged islet ?-cell function, so as to avoid it being further damage; Compared with sulfonylurea drugs, it has patients' good compliance and convenient oral, reduces the incidence of adverse reactions of hypoglycemia as well as it is cheap; Compared with ?- glucosidase inhibitors(acarbose), it reduces gastrointestinal irritation for patients and relieves stomach discomfort during chemotherapy. Research has shown that: metformin can improve the prognosis of patients with malignant tumors, and it can cause good effects in combination with metformin for patients with early breast cancer receiving adjuvant therapy; In addition, metformin inhibited the proliferation of breast cancer cells. At present there are few intervention research on breast cancer patients with sugar regulation damaged, as a relatively new research,this project is used to investigate the influence of metformin therapy on recent blood sugar levels of these patients by using early intervention with metformin on breast cancer patients with impaired glucose regulation during chemotherapy. MethodsAccording to inclusion criteria and exclusion criteria, a retrospective analysis about sixty cases of breast cancer patients treated with IGR from our department between October 2013 and October 2015 was conducted and their ages were 35~75 years old. The random division method was used to divide patients into experimental and control group and each group had thirty patients. In the treatment group, 0.25 g, bid, po. metformin was given during chemotherapy, diet was controlled and exercise was strengthened; in the control group: only diet was controlled and exercise was strengthened during chemotherapy. Blood glucose levels [fasting plasma glucose(FGB), OGTT2 h glucose(2hPG)] of these two groups before and by the end of the the second.the fourth and the sixth cycles of chemotherapy were recorded; Pathology results, patient ages, menopausal status, BMI and liver and kidney function results were collected to establish a database. Continuous variables were expressed with mean ± standard deviation( x ±s) and measurement data were expressed with the number of cases(percentage). The t test and x2 test were used for statistical analysis. p<0.05 was considered statistically significant. All data were processed using SPSS16.0 statistical software. Result1. The study enrolled sixty patients with breast cancer with IGR and they were randomly divided into experimental group and control group and each group had thirty patients, no patients dropped out.2. There were not statistically significant differences in age, breast cancer staging, BIM, triglycerides, total cholesterol, ALT, AST, and other indicators between experimental and control groups(p>0.05).3. Patients' average fasting glucose and OGTT2 h average blood glucose in the experimental group and control group increased as the chemotherapy regimen increased; compared with control group, the one in experimental group increased slower, indirectly showing that metformin intervention was effective.4. The efficacy of metformin was observed in patients during chemotherapy, ten cases in the experimental group of thirty IGR patients(33.33%) were reverted to normal glucose tolerance, while three patients(10%) in the control group of thirty patients were reverted to normal glucose tolerance; the reversal rate of the experimental group was higher compared to the one of the control group, the difference was statistically significant(p=0.036). Four cases(13.33%) in the experimental group of thirty IGR patients were changed to diabetes mellitus, ten cases(33.33%) in the control group were changed to type 2 diabetes mellitus, at the end of chemotherapy, the incidence of the experimental group of diabetes significantly reduced compared to the one of the control group(p<0.05). Comparison between two groups in fasting blood glucose and the blood sugar glucose OGTT2 h efforts showed that the experimental group was better than the control group.5. The adverse events of these two groups were slight, and there was no significant difference between two groups(p>0.05). After symptomatic treatment symptoms, no subjects withdraw from the study appeared, safety and well tolerated. Conclusion1. Breast cancer patients with impaired glucose regulation receiving multiple cycles of chemotherapy can affect their glucose metabolism, causing some patients sugar metabolism condition deteriorated, even into diabetes mellitus.2. Metformin treatment of breast cancer with chemotherapy in patients with impaired glucose regulation, can effectively control blood glucose and improve patients' glucose metabolism, delay the process of progression to diabetes mellitus.3. Metformin in this research has a good security. |
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