J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website http://www.jocmr.org

Original Article

Volume 9, Number 4, April 2017, pages 303-309

An Elevated HbA1c Level Is Associated With Short-Term Adverse Outcomes in Patients With Gastrointestinal Cancer and Type 2 Diabetes Mellitus

**Table 1.** The Characteristics of Non-T2DM and T2DM Patients With Gastrointestinal Cancer
	Non-T2DM	T2DM	P value	Patients with T2DM
Age (years, SD)	63.1 (12.5)	64.7 (10.1)	0.326	63.7 (10.5)	65.5(9.8)	0.339
Sex (n, %)			0.702			0.509
Male	51 (56.0%)	63 (53.4%)		29 (56.9%)	34 (50.7%)
Female	40 (44.0%)	55 (46.7%)		22 (43.1%)	33 (49.3%)
BMI	20.7 (3.1)	21.0 (3.0)	0.394	20.6 (2.8)	21.3 (3.2)	0.205
Cancer (n, %)			0.970			0.443
Esophagus cancer	15 (16.5%)	18 (15.3%)		10 (19.6%)	8 (11.9%)
Gastric carcinoma	33 (36.3%)	43 (36.4%)		19 (37.3%)	24 (35.8%)
Colorectal cancer	43 (47.2%)	57 (48.3%)		22 (43.1%)	35 (52.3%)
Pathological T category (n, %)			0.972			0.913
T1	15 (16.5%)	19 (16.1%)		9 (17.7%)	10 (15.0%)
T2	31 (34.1%)	38 (32.2%)		15 (29.4%)	23 (34.3%)
T3	28 (30.7%)	40 (33.9%)		17 (33.3%)	23 (34.3%)
T4	17 (18.7%)	21 (17.8%)		10 (19.6%)	11 (16.4%)
Pathological N category (n, %)			0.967			0.232
N0	23 (25.3%)	29 (24.6%)		11 (21.6%)	18 (27.0%)
N1	42 (46.1%)	52 (44.1%)		25 (49.0%)	27 (40.2%)
N2	17 (18.7%)	23 (19.5%)		12 (23.5%)	11 (16.4%)
N3	9 (9.9%)	14 (11.8%)		3 (5.9%)	11 (16.4%)
Histological differentiation (n, %)			0.256			0.070
Good	14 (15.4%)	23 (19.5%)		6 (11.8%)	17 (25.4%)
Moderate	36 (39.6%)	34 (28.8%)		12 (23.5%)	20 (29.8%)
Poor	41 (45.0%)	61 (51.7%)		33 (64.7%)	30 (44.8)
Chemotherapy (n, %)			0.920			0.737
Yes	33 (36.3%)	42 (35.6%)		19 (37.3%)	27 (40.3%)
No	58 (63.7%)	76 (64.4%)		32 (62.7%)	40 (59.7%)
Duration of T2DM (years)	-	-	-	4.9 (2.4)	6.2 (2.7)	0.510
Strict antidiabetic treatment (n, %)	-	-	-
Yes	-	-	-	24 (47.1%)	19 (28.4%)	0.037
No	-	-	-	27 (52.9%)	48 (71.6%)
Alcohol (n, %)			0.968			0.126
Yes	28 (30.8%)	36 (30.5%)		23 (45.1%)	21 (31.3%)
No	63 (69.2%)	82 (69.5%)		28 (54.9%)	46 (68.7%)
Smoking (n, %)			0.580			0.913
Yes	35 (38.5%)	41 (34.7%)		18 (35.3%)	23 (34.3%)
No	56 (61.5%)	77 (65.3%)		33 (64.7%)	44 (65.7%)

Table 1. The Characteristics of Non-T2DM and T2DM Patients With Gastrointestinal Cancer

Non-T2DM

T2DM

P value

Patients with T2DM

HbA1c < 7%

HbA1c ≥ 7%

P value

Age (years, SD)

63.1 (12.5)

64.7 (10.1)

0.326

63.7 (10.5)

65.5(9.8)

0.339

Sex (n, %)

0.702

0.509

Male

51 (56.0%)

63 (53.4%)

29 (56.9%)

34 (50.7%)

Female

40 (44.0%)

55 (46.7%)

22 (43.1%)

33 (49.3%)

BMI

20.7 (3.1)

21.0 (3.0)

0.394

20.6 (2.8)

21.3 (3.2)

0.205

Cancer (n, %)

0.970

0.443

Esophagus cancer

15 (16.5%)

18 (15.3%)

10 (19.6%)

8 (11.9%)

Gastric carcinoma

33 (36.3%)

43 (36.4%)

19 (37.3%)

24 (35.8%)

Colorectal cancer

43 (47.2%)

57 (48.3%)

22 (43.1%)

35 (52.3%)

Pathological T category (n, %)

0.972

0.913

15 (16.5%)

19 (16.1%)

9 (17.7%)

10 (15.0%)

31 (34.1%)

38 (32.2%)

15 (29.4%)

23 (34.3%)

28 (30.7%)

40 (33.9%)

17 (33.3%)

23 (34.3%)

17 (18.7%)

21 (17.8%)

10 (19.6%)

11 (16.4%)

Pathological N category (n, %)

0.967

0.232

23 (25.3%)

29 (24.6%)

11 (21.6%)

18 (27.0%)

42 (46.1%)

52 (44.1%)

25 (49.0%)

27 (40.2%)

17 (18.7%)

23 (19.5%)

12 (23.5%)

11 (16.4%)

9 (9.9%)

14 (11.8%)

3 (5.9%)

11 (16.4%)

Histological differentiation (n, %)

0.256

0.070

Good

14 (15.4%)

23 (19.5%)

6 (11.8%)

17 (25.4%)

Moderate

36 (39.6%)

34 (28.8%)

12 (23.5%)

20 (29.8%)

Poor

41 (45.0%)

61 (51.7%)

33 (64.7%)

30 (44.8)

Chemotherapy (n, %)

0.920

0.737

Yes

33 (36.3%)

42 (35.6%)

19 (37.3%)

27 (40.3%)

58 (63.7%)

76 (64.4%)

32 (62.7%)

40 (59.7%)

Duration of T2DM (years)

4.9 (2.4)

6.2 (2.7)

0.510

Strict antidiabetic treatment (n, %)

Yes

24 (47.1%)

19 (28.4%)

0.037

27 (52.9%)

48 (71.6%)

Alcohol (n, %)

0.968

0.126

Yes

28 (30.8%)

36 (30.5%)

23 (45.1%)

21 (31.3%)

63 (69.2%)

82 (69.5%)

28 (54.9%)

46 (68.7%)

Smoking (n, %)

0.580

0.913

Yes

35 (38.5%)

41 (34.7%)

18 (35.3%)

23 (34.3%)

56 (61.5%)

77 (65.3%)

33 (64.7%)

44 (65.7%)

**Table 2.** The Comparison of the Clinical Outcomes Between Non-T2DM and T2DM Patients With Gastrointestinal Cancer
	Non-T2DM	T2DM	P value	Patients with T2DM
Short-term adverse outcomes (n, %)	10 (11.0%)	26 (22.0%)	< 0.05	8 (15.7%)	18 (26.9%)	< 0.05
30-day mortality (n, %)	2 (2.2%)	3 (2.5%)	0.872	1 (2.0%)	0 (0%)	0.250
180-day mortality (n, %)	7 (7.7%)	18 (15.3%)	0.095	5 (9.8%)	13 (19.4%)	0.151
Total postoperative complications (n, %)	10 (11.0%)	22 (18.7%)	0.094	5 (9.8%)	17 (25.4%)	< 0.05
Anastomotic leak (n, %)	2 (2.2%)	3 (2.5%)	0.872	0 (0%)	3 (4.5%)	0.126
Ileus (n, %)	2 (2.2%)	4 (3.4%)	0.609	1 (2.0%)	4 (6.0%)	0.284
Others (n, %)	3 (3.3%)	4 (3.4%)	0.970	1 (2.0%)	2 (3.0%)	0.726
Infectious complications (n, %)	3 (3.3%)	12 (10.2%)	0.056	3 (5.9%)	8 (11.9%)	0.262
Pulmonary infection (n, %)	1 (1.1%)	2 (1.7%)	0.514	1 (2.0%)	1 (1.5%)	0.845
Abdominal infection (n, %)	1 (1.1%)	3 (2.5%)	0.450	0 (0%)	3 (4.5%)	0.126
Urinary infection (n, %)	0 (0%)	3 (2.5%)	0.126	2 (3.9%)	1 (1.5%)	0.406
Incisional wound infection (n, %)	1 (1.1%)	4 (3.4%)	0.283	1 (2.0%)	3 (4.5%)	0.454
Length of hospital stay (days) (n, %)	8.9 (9.7%)	13.2 (13.8%)	< 0.05	11.4 (12.4%)	14.5 (14.7%)	< 0.05

Table 2. The Comparison of the Clinical Outcomes Between Non-T2DM and T2DM Patients With Gastrointestinal Cancer

Non-T2DM

T2DM

P value

Patients with T2DM

HbA1c < 7%

HbA1c ≥ 7%

P value

Short-term adverse outcomes (n, %)

10 (11.0%)

26 (22.0%)

< 0.05

8 (15.7%)

18 (26.9%)

< 0.05

30-day mortality (n, %)

2 (2.2%)

3 (2.5%)

0.872

1 (2.0%)

0 (0%)

0.250

180-day mortality (n, %)

7 (7.7%)

18 (15.3%)

0.095

5 (9.8%)

13 (19.4%)

0.151

Total postoperative complications (n, %)

10 (11.0%)

22 (18.7%)

0.094

5 (9.8%)

17 (25.4%)

< 0.05

Anastomotic leak (n, %)

2 (2.2%)

3 (2.5%)

0.872

0 (0%)

3 (4.5%)

0.126

Ileus (n, %)

2 (2.2%)

4 (3.4%)

0.609

1 (2.0%)

4 (6.0%)

0.284

Others (n, %)

3 (3.3%)

4 (3.4%)

0.970

1 (2.0%)

2 (3.0%)

0.726

Infectious complications (n, %)

3 (3.3%)

12 (10.2%)

0.056

3 (5.9%)

8 (11.9%)

0.262

Pulmonary infection (n, %)

1 (1.1%)

2 (1.7%)

0.514

1 (2.0%)

1 (1.5%)

0.845

Abdominal infection (n, %)

1 (1.1%)

3 (2.5%)

0.450

0 (0%)

3 (4.5%)

0.126

Urinary infection (n, %)

0 (0%)

3 (2.5%)

0.126

2 (3.9%)

1 (1.5%)

0.406

Incisional wound infection (n, %)

1 (1.1%)

4 (3.4%)

0.283

1 (2.0%)

3 (4.5%)

0.454

Length of hospital stay (days) (n, %)

8.9 (9.7%)

13.2 (13.8%)

< 0.05

11.4 (12.4%)

14.5 (14.7%)

< 0.05

**Table 3.** Univariate and Multivariate Logistic Analysis for Risk Factors Associated With Short-Term Adverse Outcomes in T2DM Patients With GIC
Variable	Univariate analysis	Multivariate analysis
Age ≥ 65 years	2.39 (0.83 - 6.91)	0.108	-	-
BMI (kg/m²) < 18	2.67 (0.57 - 12.42)	0.211	-	-
Pathological T category ≥ T3-4	1.55 (0.63 - 3.85)	0.341	-	-
Pathological N category ≥ N3-4	1.28 (0.85 - 1.93)	0.236	-	-
No chemotherapy	4.08 (1.65 - 10.13)	< 0.01	2.01 (0.69 - 5.83)	0.203
HbA1c (%) ≥ 7%	3.43 (1.27 - 9.27)	< 0.05	5.28 (1.73 - 16.09)	< 0.05
Alcohol	1.475 (1.48 - 3.530)	0.383	-	-
Smoking	1.14 (0.47 - 2.782)	1.139	-	-
No strict antidiabetic treatment	5.87 (2.04 - 18.8)	< 0.01	7.65 (2.49 - 23.54)	< 0.001

Table 3. Univariate and Multivariate Logistic Analysis for Risk Factors Associated With Short-Term Adverse Outcomes in T2DM Patients With GIC

Variable

Univariate analysis

Multivariate analysis

Odds ratio (95% CI)

P value

Odds ratio (95% CI)

P value

Age ≥ 65 years

2.39 (0.83 - 6.91)

0.108

BMI (kg/m²) < 18

2.67 (0.57 - 12.42)

0.211

Pathological T category ≥ T3-4

1.55 (0.63 - 3.85)

0.341

Pathological N category ≥ N3-4

1.28 (0.85 - 1.93)

0.236

No chemotherapy

4.08 (1.65 - 10.13)

< 0.01

2.01 (0.69 - 5.83)

0.203

HbA1c (%) ≥ 7%

3.43 (1.27 - 9.27)

< 0.05

5.28 (1.73 - 16.09)

< 0.05

Alcohol

1.475 (1.48 - 3.530)

0.383

Smoking

1.14 (0.47 - 2.782)

1.139

No strict antidiabetic treatment

5.87 (2.04 - 18.8)

< 0.01

7.65 (2.49 - 23.54)

< 0.001