Glycosylated Hemoglobin A1c Is Associated with Anthropometric Measurements and Tumor Characteristics in Breast Cancer Patients

Figures & data

Table 1 Demographic and Anthropometric Characteristics of Breast Cancer Patients (N=223)

Characteristic	n (%)
Age*, years	49.9±10.3 (27–80)
18–39	36 (16.1)
40–59	139 (62.3)
>60	84 (21.5)
Marital Status
Single	19 (8.5)
Married	165 (74)
Widowed	37 (16.6)
Divorced	2 (0.9)
Menopausal Status
Premenopausal	72 (32.3)
Postmenopausal	151 (67.7)
Family History of Breast Cancer
Absent	166 (74.4)
Present	56 (25.1)
Unknown	1 (0.4)
Smoking Status
Never	180 (80.7)
Past	27 (12.1)
Current	16 (7.2)
Alcohol Intake
Never	221 (99.1)
Past	1 (0.4)
Current	1 (0.4)
Use of oral contraceptives	79 (35.4)
Use of HRT	7 (3.1)
Waist*, cm	98.8±12.4 (70.0–132.0)
<80	12 (5.4)
≥80	205 (91.9)
Missing	6 (2.7)
Waist-hip ratio*	0.86 ±0.75 (0.65–1.10)
<0.85	94 (42.2)
≥0.85	123 (55.2)
Missing	6 (2.7)
BMI*, kg/m^2	29.9±5.7 (17.7–51.1)
Normal	39 (17.5)
Overweight	72 (32.3)
Obese	108 (48.4)
Missing	4 (1.8)

Note: *Mean ± SD (range).

Abbreviations: BMI, body mass index; HRT, hormone replacement therapy.

Table 2 Description of Glycemic Status and HbA1c% Levels Among Breast Cancer Patients (N=223)

Characteristic	n (%)
Known Case of Diabetes
Yes	48 (21.5)
No	175 (78.5)
Type of Diabetes
Type I	1 (2.1)
Type II	46 (95.8)
Unknown	1 (2.1)
Age at Diagnosis, years
<40	4 (8.3)
≥40	43 (89.6)
Years Since Diagnosis
<5	16 (33.3)
≥5	31 (64.6)
Unknown	1 (2.1)
Current Anti-Diabetic Treatment
None	1 (2.1)
OHAs	35 (74.5)
Insulin	8 (17)
Insulin + OHAs	3 (6.4)
HbA1c %^†*	6.2±1.4 (4.7–12.6)
Normal	74 (42.3)
Pre-diabetic	29 (52.6)
Diabetic	9 (5.1)

Notes: ^†HbA1c levels for cases with no history of diabetes mellitus (n=175). *Mean ± SD (range).

Abbreviations: HbA1c, glycosylated hemoglobin A1c; OHAs, oral hypoglycemic agents [Metformin, sulphonylureas, and/or pioglitazone].

Table 3 Clinicopathologic Characteristics of Breast Cancer Patients (N=189)

Characteristic	n (%)
Period with Breast Cancer, years
< 1	116 (61.4)
1–5	61 (32.3)
≥ 5	10 (5.3)
Unknown	2 (1.1)
Site of the Disease
Right	86 (45.5)
Left	98 (51.9)
Bilateral	5 (2.6)
Tumor Size
T1	28 (14.8)
T2	92 (48.7)
T3	22 (11.6)
T4	3 (1.6)
Missing	44 (23.3)
Lymph Nodes Status
Positive	90 (47.6)
Negative	51 (27.0)
Missing	48 (25.4)
Stage at Diagnosis
I	10 (5.3)
II	72 (38.1)
III	58 (30.7)
IV	21 (11.1)
Missing	27 (14.3)
Grade
I	7 (3.7)
II	81 (42.9)
III	94 (49.7)
Missing	7 (3.7)
Pathologic Type
IDC	151 (79.9)
ILC	9 (4.8)
Other	29 (15.3)
ER Status
Positive	141 (74.6)
Negative	41 (21.7)
Missing	7 (3.7)
PR Status
Positive	125 (66.1)
Negative	57 (30.2)
Missing	7 (3.7)
HER2 Status
Positive	74 (39.2)
Negative	90 (47.6)
Missing	25 (13.2)
Lymphovascular Invasion
Identified	78 (41.3)
Not identified	67 (35.4)
Missing	44 (23.3)
Molecular Subtype
Luminal A	76 (40.2)
Luminal B	53 (28.0)
HER2-positive	21 (11.1)
Basal-like	14 (7.4)
Missing	25 (13.2)
Breast Cancer Treatment
None	16 (8.5)
Surgery	151 (79.9)
Radiation	70 (37.0)
Neoadjuvant chemotherapy	45 (23.8)
Adjuvant chemotherapy	108 (57.1)

Note: Other histologic subtypes included were ductal carcinoma in situ (DCIS) and mixed invasive ductal and lobular carcinoma.

Abbreviations: ER, estrogen receptor; HER2, human epidermal growth factor receptor 2; IDC, invasive ductal carcinoma; ILC, invasive lobular carcinoma; PR, progesterone receptor.

Table 4 Correlation Analysis of HbA1c Levels with Selected Anthropometric and Clinicopathologic Characteristics of Breast Cancer Patients (N=223) (Continuous Variables)

Anthropometric and Clinicopathologic Characteristics	HbA1c, %
	r	p value
Age, years	0.267	<0.001*
Waist, cm	0.180	0.008*
Waist-Hip ratio	0.278	<0.001*
BMI, kg/m^2	0.088	0.194
Tumor size, cm	0.079	0.347
Number of involved lymph nodes	0.020	0.815

Notes: r, Pearson’s correlation coefficient. *Statistical significance at p<0.05.

Abbreviations: BMI, body mass index; HbA1c, glycosylated hemoglobin A1c.

Figure 1 HbA1c levels in relation to anthropometric measurements and menopausal status of breast cancer patients. Average blood levels of HbA1c were compared according to (A) age, (B) waist circumference, (C) waist-hip ratio, (D) BMI, and (E) menopausal status of breast cancer patients. *Statistically significant at p<0.05.

Abbreviations: BMI, body mass index; HbA1c, glycosylated hemoglobin A1c.

Table 5 Association Between HbA1c with Clinicopathologic Characteristics in Breast Cancer Patients Based on Menopausal Status (N=189)

Characteristic	Premenopausal (n=61)				Postmenopausal (n=128)
	HbA1c Status				HbA1c Status
	Normal (n=25)	Prediabetic (n=31)	Diabetic (n=5)	p value	Normal (n=35)	Prediabetic (n=54)	Diabetic (n=39)	p value
Stage				0.044*				0.473
Early stage (I/II)	13 (44.8%)	13 (44.8%)	3 (10.3%)		16 (30.2%)	19 (35.8%)	18 (34.0%)
Advanced stage (III/IV)	5 (22.7%)	17 (77.3%)	0 (0.0%)		14 (24.6%)	27 (47.4%)	16 (28.1%)
Grade				0.016*				0.952
I and II	12 (44.4%)	10 (37.0%)	5 (18.5%)		17 (27.9%)	26 (42.6%)	18 (29.5%)
III	13 (38.2%)	21 (61.8%)	0 (0.0%)		17 (28.3%)	24 (40.0%)	19 (31.7%)
ER status				0.428				0.632
Positive	19 (42.2%)	21 (46.7%)	5 (11.1%)		25 (26.0%)	41 (42.7%)	30 (31.3%)
Negative	6 (42.9%)	8 (57.1%)	0 (0.0%)		8 (29.6%)	10 (37.0%)	9 (33.3%)
PR status				0.338				0.271
Positive	18 (42.9%)	19 (45.2%)	5 (11.9%)		22 (26.5%)	37 (44.6%)	24 (28.9%)
Negative	7 (41.2%)	10 (58.8%)	0 (0.0%)		12 (30.0%)	13 (32.5%)	15 (37.5%)
HER2 status				0.056				0.120
Positive	7 (25.9%)	17 (63.0%)	3 (11.1%)		13 (22.0%)	27 (45.8%)	19 (32.2%)
Negative	18 (58.1%)	11 (35.5%)	2 (6.5%)		19 (40.4%)	17 (36.2%)	11 (23.4%)
LVI				0.726				0.595
Identified	10 (38.5%)	15 (57.7%)	1 (3.8%)		17 (32.7%)	22 (42.3%)	13 (25.0%)
Not identified	10 (41.7%)	12 (50.0%)	2 (8.3%)		10 (23.3%)	17 (39.5%)	16 (37.2%)
Molecular subtype				0.201				0.039*
Luminal A	15 (57.7%)	9 (34.6%)	2 (7.7%)		13 (26.0%)	24 (48.0%)	13 (26.0%)
Luminal B	4 (22.2%)	11 (61.1%)	3 (16.7%)		12 (34.3%)	14 (40.0%)	9 (25.7%)
HER2-positive	3 (33.3%)	6 (66.7%)	0 (0.0%)		7 (58.3%)	3 (25.0%)	2 (16.7%)
Basal-like	3 (60.0%)	2 (40.0%)	0 (0.0%)		0 (0.0%)	3 (33.3%)	6 (66.7%)

Notes: Data is presented as n (%). *Statistical significance at p<0.05.

Abbreviations: BMI, body mass index; ER, estrogen receptor; HbA1c, glycosylated hemoglobin A1c; HER2, human epidermal growth factor receptor 2; LVI, lymphovascular invasion; PR; progesterone receptor.