Clinical Drug Investigation

, Volume 38, Issue 7, pp 603–610 | Cite as

Impact of Anthracyclines on Diabetes Mellitus Development in B-Cell Lymphoma Patients: A Nationwide Population-based Study

  • Chieh-Lin Jerry Teng
  • Kuang-Hsi Chang
  • I-Ju Tsai
  • Wen-Li Hwang
  • Chung Y. Hsu
  • Wayne H-H Sheu
Original Research Article


Background and Objectives

Although anthracyclines are effective chemotherapeutic agents for treating B-cell lymphoma, adverse effects, such as bone marrow suppression and cardiotoxicity, limit their clinical application. We assessed whether anthracycline treatment also increases the risk for diabetes mellitus in patients with B-cell lymphoma.


Using data obtained from the Taiwanese National Health Insurance Research Database from 2004 to 2011, we compared overall survival and clinical features for B-cell lymphoma patients administered anthracyclines (n = 3147) and those not administered anthracyclines (n = 837). The impact of anthracycline treatment on diabetes risk was further investigated using a Gray’s test and multivariate competing-risk regression models in a dose-dependent manner.


Anthracycline administration was associated with a higher incidence of diabetes (HR: 1.75; 95% CI 1.11–2.75; p = 0.0163) after adjustments for age, gender, cumulative dose of prednisolone, and co-morbidities. Cumulative anthracycline doses of 253–400 mg (HR: 2.35; 95% CI 1.41–3.91; p = 0.0010), 401–504 mg (HR: 2.26; 95% CI 1.26–4.05; p = 0.0063), and > 504 mg (HR: 2.29; 95% CI 1.25–4.18; p = 0.0072) increased the incidence density of diabetes in a dose-dependent manner (p = 0.0006). The annual alteration of adapted diabetes complications severity index score was not significantly different between B-cell lymphoma patients with or without anthracycline treatment (p = 0.4924).


Anthracycline therapy increases diabetes risk in a dose-dependent manner in B-cell lymphoma patients. Intensive blood glucose monitoring and control should be recommended for B-cell lymphoma patients receiving anthracycline treatment.


Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflicts of interest.


This work was supported by grants from the Ministry of Health and Welfare, Taiwan (MOHW107-TDU-B-212-123004), China Medical University Hospital, Academia Sinica Taiwan Biobank Stroke Biosignature Project (BM10701010021), Taiwan Clinical Trial Consortium for Stroke (MOST 106-2321-B-039-005), Tseng-Lien Lin Foundation, Taichung, Taiwan, Taiwan Brain Disease Foundation, Taipei, Taiwan, and Katsuzo and Kiyo Aoshima Memorial Funds, Japan.

Ethical approval

The institutional review board of the China Medical University Hospital approved this study (CMUH104-REC2-115). For this type of study, formal informed consent is not required by the institutional review board.


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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Chieh-Lin Jerry Teng
    • 1
    • 2
    • 3
  • Kuang-Hsi Chang
    • 4
  • I-Ju Tsai
    • 5
  • Wen-Li Hwang
    • 1
  • Chung Y. Hsu
    • 6
  • Wayne H-H Sheu
    • 7
  1. 1.Division of Hematology/Medical Oncology, Department of MedicineTaichung Veterans General HospitalTaichungTaiwan
  2. 2.Department of Life ScienceTunghai UniversityTaichungTaiwan
  3. 3.School of MedicineChung Shan Medical UniversityTaichungTaiwan
  4. 4.Graduate Institute of Biomedical SciencesChina Medical UniversityTaichungTaiwan
  5. 5.Management Office for Health DataChina Medical University HospitalTaichungTaiwan
  6. 6.Graduate Institute of Clinical Medical ScienceChina Medical UniversityTaichungTaiwan
  7. 7.Division of Endocrinology and Metabolism, Department of MedicineTaichung Veterans General HospitalTaichungTaiwan

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