With new research strengthening the link between diabetes and cancer development, the number of people grappling with both conditions has grown. To raise awareness for pharmacists and other health professions about the challenges those patients face, a new study looked at how dual diagnosis affects diabetes management.
The article in the American Journal of Clinical Oncology pointed out that cancer patients with comorbid diabetes have a 50% increased risk of all-cause mortality compared with cancer patients without diabetes. One hypothesis, according to Weill Cornell Medicine researchers, is that worse outcomes might be mediated by less attention to diabetes management.
Patient in Hospital Bed. Source: Getty Images
The authors pointed out that patients tend to focus less on glucose control, medication adherence, and diabetes self-management behaviors during active cancer treatment. In light of that, they conducted a systematic review is to determine and quantify how a cancer diagnosis affects diabetes management.
The researchers searched for quantitative and qualitative studies evaluating diabetes management in 4 databases: MEDLINE, EMBASE, The Cochrane Library, and Web of Science. Two independent reviewers extracted data and summarized results from eligible studies. Study quality was formally assessed.
While 36 studies met all inclusion criteria, the authors noted that findings were inconsistent across studies.
“Although the effects of a cancer diagnosis on diabetes management are mixed, when results across studies were synthesized together, diabetes management appeared to generally decline after a cancer diagnosis,” researchers wrote. “Declines in diabetes management seem to be primarily due to shifts in the priority of care from diabetes management to cancer. A next critical step in this line of work is to identify patient and provider level predictors of better or worse diabetes management to design and test interventions aimed at improving effective diabetes management for cancer patients.”
A study in BMC Endocrine Disorders emphasized that, with survival from many cancer types steadily increasing, a growing number of cancer patients are continuing to live with other chronic diseases. Diabetes is one of the most prevalent, the report pointed out.
Danish researchers sought to describe the impact of cancer on health outcomes in patients with type 2 diabetes and to compare the effectiveness of a multifactorial intervention in diabetes patients with and without cancer.
To do that, researchers conducted the Diabetes Care in General Practice (DCGP) randomized controlled trial, which included 1,381 patients newly diagnosed with type 2 diabetes. For the study, participants were randomized to either six years of structured personal diabetes care or routine care. In a post hoc analysis, the study team followed patients for 19 years in Danish national registries for the occurrence of diabetes-related outcomes.
At the time of the diabetes diagnosis, 48 patients had cancer, and 243 patients were diagnosed with cancer during follow up, according to the report, which found that diabetes patients with cancer had excess all-cause mortality (HR 3.33; 95%CI 2.72–4.06). Those patients also had an increased incidence of myocardial infarction (HR 1.76; 95%CI 1.29–2.39) and any diabetes-related outcome (HR 1.36; 95%CI 1.07–1.71), according to the researchers.
“The observed positive effect of structured personal diabetes care on clinical outcomes did not differ between patients with and without cancer,” the authors concluded. “Attention to and prevention of diabetes complications in patients with both type 2 diabetes and cancer is warranted.”