Insulin resistance in patients with cancer: a systematic review and meta-analysis.
Level 3 - non-randomized controlled study
Systematic review and meta-analysis of observational case-control studies using gold-standard clamp measurements
PubMed 37042166 · doi:10.1080/0284186X.2023.2197124
What was done
Systematic review and meta-analysis following PRISMA guidelines, searching MEDLINE, Embase, and Cochrane Central Register of Controlled Trials from inception through March 2023. Eligible studies included adult cancer patients alongside age-matched non-cancer controls and measured insulin sensitivity using the hyperinsulinemic-euglycemic clamp technique.
What was found
Fifteen studies met the eligibility criteria (187 patients with cancer, 154 controls). The mean insulin-stimulated rate of glucose disposal (Rd) was 4.7 mg/kg/min in cancer patients compared to 7.5 mg/kg/min in control subjects. The pooled mean difference was -2.61 mg/kg/min (95% CI: -3.04 to -2.19, p < 0.01). Study heterogeneity was not statistically significant (p = 0.24).
Why it matters
By aggregating studies using the gold-standard clamp method, this review demonstrates that insulin resistance is common and pronounced in patients with cancer. It supports testing metabolic interventions to determine if improving insulin sensitivity alters recurrence rates or overall survival.
Limits
The total sample size is small (341 participants across 15 studies). The abstract does not report data on specific cancer types, staging, nutritional status, body mass index matching, or concurrent antineoplastic treatments, and the observational design cannot determine causality.
Cited by
- supports The hyperinsulinemic-euglycemic clamp technique is the gold standard method for measuring insulin sensitivity.