To Improve Multiple Myeloma Survival, Diabetes Management Cannot Be Ignored

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Patients with cancer and diabetes need to carefully co-manage both diseases, as one expert tells CURE.

To improve multiple myeloma, diabetes management must be acknowledged

Researchers are advising that, in order to improve survival among patients with multiple myeloma, “(diabetes) management cannot be ignored,” according to findings from a recent study.

Multiple myeloma (MM) is twice as common among Black patients than White patients, and rates of diabetes mellitus (DM) are also far higher among Black patients than White patients. Findings from a retrospective clinical study of 5,383 patients with multiple myeloma, 15% of which had diabetes (12% White and 25% Black), published in the journal Blood Advances, showed survival to be higher among patients with multiple myeloma who did not have diabetes.

Among all patients, survival rates were 1.27 times higher among patients who did not have diabetes, and for White patients without diabetes survival was 1.35 times more likely. However, not having diabetes only improved Black patients’ survival by 1.08 times, and there was no statistical significance in survival between White and Black patients, regardless of diabetes status.

Although diabetes rates increase alongside BMI and age, researchers found diabetes to disproportionately impact younger and normal weight Black patients with multiple myeloma. The researchers also found that an increased rate of diabetes alongside BMI and age was prevalent among Black patients with multiple myeloma when compared with White patients.

“The racial differences in OS (overall survival, the time following treatment that a patient lives regardless of disease status) in patients with and without DM was an unexpected finding, where White patients with DM had a worse OS compared to those without DM, but this was not seen in Black patients,” researchers wrote. “The prevalence of DM usually increases with advancing age, which we observed in our Black and White cohorts; however, the prevalence of DM was 50% higher in younger Black patients (45 to 60 years) than older White patients (>60 years). While age >60 years was an independent risk factor for mortality in both groups, it is possible that we found no association between DM and OS in the Black population with DM because they were a younger population than the White population with DM, and therefore potentially had better tolerance to MM treatments, and their potential complications, than the older White population with DM.”

“The diabetes does matter.”

For patients with cancer who are co-managing other conditions, clear communication with their care team is crucial, as Dr. Brandon Blue, a clinical instructor in the Department of Malignant Hematology at Moffitt Cancer Center in Florida, told CURE.

“Be vocal to your doctor and let them know that you have diabetes and (make sure) that your doctor is aware of it, first of all,” Blue advised. “Because sometimes, as cancer doctors, I must admit, we get so entangled about the cancer and treating the cancer, sometimes we forget some of the other diagnoses that these patients have.”

Additionally, Blue noted that “as a patient, you have to be kind of your best advocate to make sure that you actually are checking your blood sugar. … We give people so much information about chemotherapy and all the side effects of those things that sometimes people forget about their blood pressure medicines or their diabetes medicines, just because the chemo and the cancer is really the scary thing and the big thing on the front of people's minds. And so, I don't want people to forget about some of these other issues, because clearly it states in this study, that the diabetes does matter.”

Learn more: Watch Dr. Blue’s presentation on health disparities from this year’s Educated Patient® Multiple Myeloma Summit

A factor that patients and providers need to remain cognizant of, Blue explained, is medication.

“One of the main medications that we give in multiple myeloma is steroids, and unfortunately, the main side effect of steroids is raising the (patient’s) blood sugar,” Blue said. “So as a byproduct, (for) those patients who do have diabetes, unfortunately, for the period of time that they're on the intensive treatment for the myeloma their diabetes may be worse.

“Now, the conversation should really go into where if we know that the diabetes is already there ahead of time, then maybe there are some things we need to (do, such as) adjust the medications even before we start (treatment), to anticipate that they're likely going to raise the blood sugar with the multiple myeloma treatment so that we're not the cat chasing the tail.”

Mindful co-management of cancer with other diseases is consistent with the push in the oncology realm towards personalized medicine, Blue said

“That means that the person right next to you with the same exact diagnosis may get different treatment,” he explained. “And so that's what we think we're going to head towards and likely with that, one of those factors could be diabetes and (we could) say, ‘Hey, this person has really poorly controlled diabetes, let's factor that into the equation. And let's actually give them a treatment that's a little bit more tailored to their disease.’”

Questions remain, according to the authors of the Blood Advances study.

“The underlying basis for increased incidence of MM in Black patients is not known,” researchers noted. “Genome-wide association studies account for approximately 15% of the heritable risk. Unique loci in Black individuals have not been identified, suggesting factors beyond genetics including DM and obesity may be contributing, given that they affect the Black population to a greater degree than in the White population.”

“We're still trying to decide, is this a nature versus a nurture issue? Meaning, is this something that is inherently in the biology of the cancer cells in a certain group of people that makes their biology of their cancer different, or is this basically a social issue where the biology is the same, but the circumstances of the people that are within that biology, unfortunately, are different in those circumstances, (which) are what’s leading to those worse outcomes?” Blue said. “We still don’t have a really good answer to that.

“Because then we need to figure out, once we can answer that, how to direct our efforts. Meaning that if we know that there are certain biological differences then we can actually find targets (to) change the natural course of some of the more aggressive biology types. Or, if we say, ‘Hey, this is really not a biological issue. This is more of a social construct,’ then let's focus our attention there, to help with what they call the social determinants of health and make sure that those things are leading to equal access.”

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