癌症被认为是一种新出现的糖尿病并发症，患糖尿病的患者患癌症的发病率更高，预后更差。癌症通常与虚弱症（一种导致消耗的全身代谢疾病）有关。目前不清楚糖尿病如何影响虚弱症的发展和进展。我们在一组345名患有结直肠和胰腺癌的患者中，回顾性地调查了糖尿病和癌症虚弱症之间的相互作用。我们记录了这些患者的体重、脂肪量、肌肉量、临床血清值和生存情况。患者根据先前的诊断分为糖尿病/非糖尿病组或者根据体重指数分为肥胖/非肥胖组（BMI ≥30kg/m2 被视为肥胖）。癌症患者中2型糖尿病的既往存在，但不是肥胖，导致虚弱症发病率增加（80%比没有糖尿病的61%，p≤0.05），体重下降更多（8.9% vs. 6.0%，p≤0.001），生存概率降低（中位生存天数：689 vs. 538，Chi square=4.96，p≤0.05），而这与初始体重或肿瘤进展无关。患有糖尿病的癌症患者显示出更高的C反应蛋白血清水平（0.919 μg/mL vs. 0.551 μg/mL，p≤0.01）和白细胞介素6水平（5.98 pg/mL vs. 3.75 pg/mL，p≤0.05），以及较低的血清白蛋白水平（3.98 g/dL vs. 4.18 g/dL，p≤0.05），相较于没有糖尿病的癌症患者。在对胰腺癌患者的亚分析中，既往存在的糖尿病加重了体重下降（9.95% vs. 6.93%，p≤0.01），并增加了住院时间（24.41天 vs. 15.85天，p≤0.001）。此外，糖尿病加重了虚弱症的临床表现，因为患有糖尿病和虚弱症共存的患者的生物标志物变化比没有糖尿病的虚弱症患者更为显着（C反应蛋白：2.300 μg/mL vs. 0.571 μg/mL，p≤0.0001；血红蛋白：11.24 g/dL vs. 12.52 g/dL，p≤0.05）。我们首次展示了既往存在的糖尿病如何加重患有结直肠和胰腺癌的虚弱症的发展。在考虑共存糖尿病和癌症的患者的虚弱症生物标志物和体重管理时，这一点非常重要。版权所有 © 2023 The Author(s)。Elsevier GmbH发表，版权所有。

Cancer is considered an emerging diabetes complication, with higher incidence and worse prognosis in patients with diabetes. Cancer is frequently associated with cachexia, a systemic metabolic disease causing wasting. It is currently unclear how diabetes affects the development and progression of cachexia.We investigated the interplay between diabetes and cancer cachexia retrospectively in a cohort of 345 patients with colorectal and pancreatic cancer. We recorded body weight, fat mass, muscle mass, clinical serum values, and survival of these patients. Patients were grouped either into diabetic/non-diabetic groups based on previous diagnosis, or into obese/non-obese groups based on body mass index (BMI≥30kg/m2 was considered obese).The pre-existence of type 2 diabetes, but not obesity, in patients with cancer led to increased cachexia incidence (80%, compared to 61% without diabetes, p≤0.05), higher weight loss (8.9 % vs. 6.0 %, p≤0.001), and reduced survival probability (median survival days: 689 vs. 538, Chi square=4.96, p≤0.05) irrespective of the initial body weight or tumor progression. Patients with diabetes and cancer showed higher serum levels of C-reactive protein (0.919 μg/mL vs. 0.551 μg/mL, p≤0.01) and interleukin 6 (5.98 pg/mL vs. 3.75 pg/mL, p≤0.05) as well as lower serum albumin levels (3.98 g/dL vs. 4.18 g/dL, p≤0.05) than patients with cancer without diabetes. In a sub-analysis of patients with pancreatic cancer, pre-existing diabetes worsened weight loss (9.95% vs. 6.93%, p≤0.01), and increased the duration of hospitalization (24.41 days vs. 15.85 days, p≤0.001). Further, diabetes aggravated clinical manifestations of cachexia, as changes in the aforementioned biomarkers were more pronounced in patients with diabetes and cachexia co-existence, compared to cachectic patients without diabetes (C-reactive protein: 2.300 μg/mL vs. 0.571 μg/mL, p≤0.0001; hemoglobin: 11.24 g/dL vs. 12.52 g/dL, p≤0.05).We show for the first time that pre-existing diabetes aggravates cachexia development in patients with colorectal and pancreatic cancer. This is important when considering cachexia biomarkers and weight management in patients with co-existing diabetes and cancer.Copyright © 2023 The Author(s). Published by Elsevier GmbH.. All rights reserved.