Abstract：
OBJECTIVE: The purpose of the study was to compare the individual and total number of symptoms and explore symptom clusters by hyperglycemia status in colorectal cancer survivors (CRCS) with diabetes (type 2).
METHODS: A retrospective cohort study was conducted, whereby symptom data were extracted from clinical notes in electronic health records. CRCS (stage II or III) diagnosed between 2007 and 2017 who had diabetes and at least one HbA1c within 8 months of initial chemotherapy were included. Zero-inflated negative binomial regression analysis was used to examine total symptoms by hyperglycemia status (hyperglycemia versus no hyperglycemia). Exploratory factor analysis was conducted to identify symptom clusters.
RESULTS: Two hundred forty-three CRCS met inclusion criteria. CRCS with hyperglycemia (HbA1c ≥ 6.5%) had greater individual symptoms (fatigue and depression) and total number of symptoms than those with no hyperglycemia. Two distinct symptom clusters, with five (nausea, vomiting, constipation, fatigue, and peripheral neuropathy) and two symptoms (anxiety and depression), were identified among CRCS with hyperglycemia.
CONCLUSIONS: These findings indicate that CRCS with diabetes and hyperglycemia had more symptoms and two distinct symptom clusters compared to those with no hyperglycemia. Prospective research studies are needed to examine the role of hyperglycemia in symptoms among CRCS with diabetes. Understanding hyperglycemia\'s influence is important as it is a modifiable risk factor towards which prevention and intervention can be directed, potentially mitigating symptoms and symptom clusters and improving outcomes for CRCS with diabetes.
METHODS: A retrospective cohort study was conducted, whereby symptom data were extracted from clinical notes in electronic health records. CRCS (stage II or III) diagnosed between 2007 and 2017 who had diabetes and at least one HbA1c within 8 months of initial chemotherapy were included. Zero-inflated negative binomial regression analysis was used to examine total symptoms by hyperglycemia status (hyperglycemia versus no hyperglycemia). Exploratory factor analysis was conducted to identify symptom clusters.
RESULTS: Two hundred forty-three CRCS met inclusion criteria. CRCS with hyperglycemia (HbA1c ≥ 6.5%) had greater individual symptoms (fatigue and depression) and total number of symptoms than those with no hyperglycemia. Two distinct symptom clusters, with five (nausea, vomiting, constipation, fatigue, and peripheral neuropathy) and two symptoms (anxiety and depression), were identified among CRCS with hyperglycemia.
CONCLUSIONS: These findings indicate that CRCS with diabetes and hyperglycemia had more symptoms and two distinct symptom clusters compared to those with no hyperglycemia. Prospective research studies are needed to examine the role of hyperglycemia in symptoms among CRCS with diabetes. Understanding hyperglycemia\'s influence is important as it is a modifiable risk factor towards which prevention and intervention can be directed, potentially mitigating symptoms and symptom clusters and improving outcomes for CRCS with diabetes.
摘要：
目的：本研究的目的是比较患有糖尿病（2型）的结直肠癌幸存者（CRCS）的个体和总症状数量，并通过高血糖状态探索症状群。
方法：进行了一项回顾性队列研究，因此，症状数据是从电子健康记录中的临床记录中提取的。包括在2007年至2017年之间诊断的CRCS（II期或III期），其患有糖尿病，并且在初始化疗的8个月内至少有一个HbA1c。使用零膨胀负二项回归分析根据高血糖状态(高血糖与无高血糖)检查总症状。进行探索性因素分析以识别症状群。
结果：二百四十三个CRCS符合纳入标准。与没有高血糖的人相比，具有高血糖的CRCS（HbA1c≥6.5％）的个体症状（疲劳和抑郁）和症状总数更大。两个不同的症状群，五（恶心，呕吐,便秘,疲劳,和周围神经病变）和两种症状（焦虑和抑郁），在CRCS中发现高血糖。
结论：这些研究结果表明，与没有高血糖的患者相比，有糖尿病和高血糖的CRCS有更多的症状和两个不同的症状群。需要进行前瞻性研究以检查高血糖在CRCS合并糖尿病症状中的作用。了解高血糖的影响是重要的，因为它是一个可改变的危险因素，预防和干预可以针对。可能减轻症状和症状群，并改善CRCS合并糖尿病的结局。
方法：进行了一项回顾性队列研究，因此，症状数据是从电子健康记录中的临床记录中提取的。包括在2007年至2017年之间诊断的CRCS（II期或III期），其患有糖尿病，并且在初始化疗的8个月内至少有一个HbA1c。使用零膨胀负二项回归分析根据高血糖状态(高血糖与无高血糖)检查总症状。进行探索性因素分析以识别症状群。
结果：二百四十三个CRCS符合纳入标准。与没有高血糖的人相比，具有高血糖的CRCS（HbA1c≥6.5％）的个体症状（疲劳和抑郁）和症状总数更大。两个不同的症状群，五（恶心，呕吐,便秘,疲劳,和周围神经病变）和两种症状（焦虑和抑郁），在CRCS中发现高血糖。
结论：这些研究结果表明，与没有高血糖的患者相比，有糖尿病和高血糖的CRCS有更多的症状和两个不同的症状群。需要进行前瞻性研究以检查高血糖在CRCS合并糖尿病症状中的作用。了解高血糖的影响是重要的，因为它是一个可改变的危险因素，预防和干预可以针对。可能减轻症状和症状群，并改善CRCS合并糖尿病的结局。
