1459-P: Impact of Endocrine Adjuvant Therapy for Breast Cancer on Diabetes Risk—A Population-Based Study

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Introduction and Objective: Rapid changes in estrogen levels while undergoing adjuvant endocrine therapy for breast cancer may have an adverse glycemic impact. This study is designed to determine the risk of diabetes mellitus (DM) in women on endocrine adjuvant therapy for treatment of non-metastatic breast cancer in the Rochester Epidemiology Project (REP) records-linkage system. Methods: A cohort of 9771 women aged 18 and over with a primary breast malignancy diagnosis was defined within the REP resources and screened for eligibility. Index date was defined as the date of breast cancer diagnosis. DM was diagnosed based on ADA criteria, a new DM diagnosis code or start of a new medication for DM. Baseline characteristics were compared between those who did and did not use aromatase inhibitors (AI). Univariate Cox regression models to evaluate the risk of DM, using AI and tamoxifen as time dependent variables, and multivariable models adjusted for age, body mass index (BMI) and baseline fasting glucose were utilized. Results: From our initial cohort, 3882 women met the criteria for inclusion. Women who used AI were older, were more frequently white, had higher BMI, and had more prior glucocorticoid use. 334 women progressed to DM. Univariate models for time from breast cancer diagnosis to onset of DM (or to follow-up if no DM), showed a significantly increased risk with AI [HR 1.38 (1.10-1.73), p 0.006] and a significantly decreased risk with tamoxifen [HR 0.52 (0.37-0.72), p <0.001]. In multivariable models, after adjustment for age, BMI and fasting glucose, AI were no longer significantly associated, but the reduced risk associated with tamoxifen remained. Conclusion: Risk of DM was greater in women on AI for breast cancer, but this increased risk was not significant after adjustment for covariates. Tamoxifen was associated with a lower risk for DM that remained significant after adjustment. Prospective comparative studies are needed to provide more insight into their glycemic effects. Disclosure V. Srinivasan: None. S.B. Prabu: None. C. Smith: None. C. Wood-Wentz: None. K.R. Bailey: None. A. Vella: Research Support; Novo Nordisk A/S, Dexcom, Inc. Advisory Panel; Boehringer-Ingelheim, Rezolute. A.M. Egan: None. K. Muthusamy: None.

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