Type II Diabetes Mellitus increases the incidence, recurrence, and progression of bladder cancer, with a chronic diabetic’s risk of acquiring bladder cancer approaching that of a smoker. With BCG and other first-line treatments showing high one-year recurrence rates, new strategies are desperately needed to treat this disease. Uninvestigated are novel dietary interventions, specifically, whether tighter glucose control can lead to improved bladder cancer outcomes in diabetic patients. We aimed to study this question by first performing a multidisciplinary pilot trial.
We recruited five subjects with Type II Diabetes or Prediabetes who were scheduled for standard Southwestern Oncology Group (SWOG) BCG protocol for a year-long intensive diet and lifestyle intervention. This intervention was comprised of three main goals: reducing carbohydrate intake to less than 130 grams per day and participating in 30 minutes of walking five times per week. Subjects had their compliance with these goals assessed at each study visit, as well as received intensive nutritional and lifestyle counseling from a registered dietician based on the Diabetes Prevention program. Given the greater frequency of office visits required in these first three months of SWOG BCG schedule, we chose to divide our study into Introduction and Post-Introduction Phases, with the first three months defined as introduction and the remainder of the study defined as post-introduction. The greater density of visits during the introduction phase allowed for more frequent counseling and assessment of compliance, with the intention that this earlier frequency would improve later adherence.
Overall compliance with the intervention was good: adherence was 60% to our carbohydrate goal and 84% to our exercise goals. Not only did our participants show a 44% reduction in carbohydrate intake compared to baseline, but specific reductions in refined grains and added sugar. Our participants saw improvement in glycemic measures over the study duration, with reductions in HbA1c, fasting blood glucose, fasting insulin, and time out of target-range on continuous glucose monitoring. While we were unable to evaluate cancer-specific outcomes, we saw immense promise in the feasibility and potential of this intervention in patients with NMIBC and Type II Diabetes. As a future direction, we hope to pursue a multi-system intervention with a larger study size and greater ability to assess tumor recurrence.
Written by: Connor Chestnut, Woodson Smelser, Travis Dum, Misty Bechtel, Lauren Hand, Carrie Michel, Areej Bawajeeh, Sepideh Zohreh, Weiya Liu, Shrikant Anant, David Robbins, Jeffrey M Holzbeierlein, Jill Hamilton-Reeves, Eugene K Lee
Department of Urology, University of Kansas Medical Center, Kansas City, KS, USA., Department of Dietetics and Nutrition, University of Kansas Medical Center, Kansas City, KS, USA., Department of Cancer Biology, University of Kansas Medical Center, Kansas City, KS, USA., Department of Internal Medicine, Diabetes Institute, University of Kansas Medical Center, Kansas City, KS, USA.
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