{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,22]],"date-time":"2025-12-22T01:41:00Z","timestamp":1766367660354,"version":"3.48.0"},"reference-count":31,"publisher":"Walter de Gruyter GmbH","issue":"1","license":[{"start":{"date-parts":[[2025,1,1]],"date-time":"2025-01-01T00:00:00Z","timestamp":1735689600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,10,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Patients with locally advanced breast cancer (LABC) and type 2 diabetes mellitus (T2DM) confront dual challenges: hormone-driven tumor progression and metabolic dysregulation. Although metformin has shown antitumor potential, its effect on estrogen modulation and synergy with nursing care remains unclear in clinical settings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>To investigate the impact of metformin on estrogen regulation and prognosis-related nursing outcomes in patients with LABC and T2DM.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This multicenter retrospective cohort study with a prospective randomized intervention component evaluated clinical, metabolic, and care-related indicators during the perioperative period. Serum estradiol (E2) was measured at baseline, post-chemotherapy, and 30 days post-surgery. Glucose metabolism was assessed by fasting blood glucose, HbA1c, and CV%, alongside hypoglycemia monitoring. Care quality metrics included wound healing time, infection rate, chemotherapy adherence, and hospital stay length. Survival outcomes (36-month PFS and OS) were analyzed via Kaplan\u2013Meier curves and Cox models adjusted for age, BMI, and tumor stage. Statistical analysis used SPSS 26.0; continuous variables were expressed as mean \u00b1 SD, compared with\n                      <jats:italic>t<\/jats:italic>\n                      -tests; HRs and 95% CIs were reported with\n                      <jats:italic>P<\/jats:italic>\n                      &lt; 0.05 considered significant.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Metformin led to a 19.3% reduction in E2 levels post-chemotherapy, with sustained suppression, outperforming the control group. Glycemic metrics improved: fasting glucose compliance rose to 83.3%, CV% decreased by 38.2%, and hypoglycemia dropped by 66.7%. Wound healing time was shortened by 3.3 days. Chemotherapy adherence reached 92.8% (vs 73.6%) and self-care scores improved by 25.8% (vs 7.2%). Mechanistic analysis indicated enhanced immune microenvironment regulation and reduced pro-inflammatory cytokines.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Metformin, combined with structured nursing care, significantly improves estrogen control, metabolic stability, and survival in LABC patients with T2DM. These findings support its role in integrated pharmaco-nursing management of tumor-metabolic comorbidities.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1515\/med-2025-1262","type":"journal-article","created":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T08:58:46Z","timestamp":1760173126000},"source":"Crossref","is-referenced-by-count":0,"title":["Metformin and estrogen modulation in LABC with T2DM: A 36-month randomized trial"],"prefix":"10.1515","volume":"20","author":[{"given":"Fengjia","family":"Liu","sequence":"first","affiliation":[{"name":"No. 971 Hospital of the People\u2019s Liberation Army Navy , Qingdao , Shandong, 266000 , China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chunhong","family":"Xu","sequence":"additional","affiliation":[{"name":"No. 971 Hospital of the People\u2019s Liberation Army Navy , Qingdao , Shandong, 266000 , China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yingcheng","family":"Bai","sequence":"additional","affiliation":[{"name":"No. 971 Hospital of the People\u2019s Liberation Army Navy , Qingdao , Shandong, 266000 , China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ying","family":"Yuan","sequence":"additional","affiliation":[{"name":"No. 971 Hospital of the People\u2019s Liberation Army Navy , Qingdao , Shandong, 266000 , China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"374","published-online":{"date-parts":[[2025,10,6]]},"reference":[{"doi-asserted-by":"crossref","unstructured":"Mont\u00e9gut L, L\u00f3pez-Ot\u00edn C, Kroemer G. 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