title: The association of hyperglycemia and diabetes mellitus and the risk of chemotherapy-induced neutropenia among cancer patients: A systematic review with meta-analysis.
abstract: Conduct a systematic review with meta-analysis to determine the association between incident chemotherapy-induced neutropenia (CIN) and either diabetes mellitus (DM) or hyperglycemia in patients with cancer.
  
  
  
  Observational studies in cancer patients of any age receiving chemotherapy and having diabetes or hyperglycemia either during or before chemotherapy induction were included. Studies were retrieved by searching four databases (PubMed, EBSCO, ProQuest, and Cochrane) and cross-referencing. The metric for combining studies was the odds ratio (OR). Results were pooled using a random-effects model, while heterogeneity and inconsistency were assessed using the Q and I2statistic, respectively. Potential small-study effects were assessed using the funnel plot.
  
  
  
  Ten studies met the criteria for inclusion. Overall, the odds of having CIN were 32% higher among cancer patients with either DM or hyperglycemia compared with those without DM or hyperglycemia (OR=1.32, 95% CI, 1.06-1.64). Statistically significant heterogeneity and inconsistency were found (Q=33.15, p<0.05, I2=72.9%). Funnel plot asymmetry reflecting potential small-study effects was observed.
  
  
  
  Diabetes mellitus and hyperglycemia may be associated with an increased risk for CIN among cancer patients. However, additional well-designed studies are needed before any final and definitive recommendations can be made.
authors.affiliation: Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, WV 26506, USA. Electronic address: eoalenzi@mix.wvu.edu.
authors.forename: Ebtihag O
authors.initials: EO
authors.lastname: Alenzi
authors.affiliation: Department of Biostatistics, School of Public Health, West Virginia University, Morgantown, WV 26506-9190, USA. Electronic address: gkelley@hsc.wvu.edu.
authors.forename: George A
authors.initials: GA
authors.lastname: Kelley
mesh_terms: D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects* / Q000627:therapeutic use; D048909:Diabetes Complications / Q000097:blood / Q000188:drug therapy*; D006801:Humans; D006943:Hyperglycemia / Q000150:complications* / Q000517:prevention & control; D009369:Neoplasms / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D009503:Neutropenia / Q000139:chemically induced* / Q000453:epidemiology; D015203:Reproducibility of Results; D012306:Risk
chemical_list: D000970:Antineoplastic Agents
keywords: Chemotherapy; Diabetes mellitus; Hyperglycemia; Meta-analysis; Neutropenia; Systematic review