Understanding the Prevalence of Prediabetes and Diabetes in Patients With Cancer in Clinical Practice: A Real-World Cohort Study

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  • 1 Department of Family and Preventive Medicine, School of Medicine,
  • | 2 Huntsman Cancer Institute, and
  • | 3 Department of Population Health Sciences, School of Medicine, Salt Lake City, Utah;
  • | 4 Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee; and
  • | 5 Data Science Service, University of Utah,
  • | 6 Huntsman Cancer Registry, University of Utah Hospital, and
  • | 7 Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City, Utah.
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Background: This study aimed to understand the prevalence of prediabetes (preDM) and diabetes mellitus (DM) in patients with cancer overall and by tumor site, cancer treatment, and time point in the cancer continuum. Methods: This cohort study was conducted at Huntsman Cancer Institute at the University of Utah. Patients with a first primary invasive cancer enrolled in the Total Cancer Care protocol between July 2016 and July 2018 were eligible. Prevalence of preDM and DM was based on ICD code, laboratory tests for hemoglobin A1c, fasting plasma glucose, nonfasting blood glucose, or insulin prescription. Results: The final cohort comprised 3,512 patients with cancer, with a mean age of 57.8 years at cancer diagnosis. Of all patients, 49.1% (n=1,724) were female. At cancer diagnosis, the prevalence of preDM and DM was 6.0% (95% CI, 5.3%–6.8%) and 12.2% (95% CI, 11.2%–13.3%), respectively. One year after diagnosis the prevalence was 16.6% (95% CI, 15.4%–17.9%) and 25.0% (95% CI, 23.6%–26.4%), respectively. At the end of the observation period, the prevalence of preDM and DM was 21.2% (95% CI, 19.9%–22.6%) and 32.6% (95% CI, 31.1%–34.2%), respectively. Patients with myeloma (39.2%; 95% CI, 32.6%–46.2%) had the highest prevalence of preDM, and those with pancreatic cancer had the highest prevalence of DM (65.1%; 95% CI, 57.0%–72.3%). Patients who underwent chemotherapy, radiotherapy, or immunotherapy had a higher prevalence of preDM and DM compared with those who did not undergo these therapies. Conclusions: Every second patient with cancer experiences preDM or DM. It is essential to foster interprofessional collaboration and to develop evidence-based practice guidelines. A better understanding of the impact of cancer treatment on the development of preDM and DM remains critical.

Submitted May 18, 2020; final revision received September 10, 2020; accepted for publication September 11, 2020.

Published online March 10, 2021.

Author contributions: Study concept and design: Ose, Viskochil, Holowatyj, Ulrich. Funding acquisition: Ose, Holowatyj, Haaland, Ulrich. Data acquisition: Larson, Wilson, Deshmukh, Butcher, Taylor, Svoboda. Statistical analysis: Tingey, Haaland. Data interpretation: Ose, Viskochil, Holowatyj, Dunson, Fisher. Manuscript preparation: Ose. Critical revision: Viskochil, Holowatyj, Larson, Wilson, Dunson, Deshmukh, Butcher, Taylor, Svoboda, Leiser, Tingey, Haaland, Wetter, Fisher, Hashibe, Ulrich. Administrative, technical, or material support: Larson. Supervision: Leiser, Wetter, Fisher, Hashibe, Ulrich.

Disclosures: Dr. Ulrich has disclosed that due to her position as Cancer Center Director, she oversees research funded by several pharmaceutical companies but has not received funding directly herself. The remaining authors have disclosed that they have not received any financial consideration from any person or organization to support the preparation, analysis, results, or discussion of this article.

Funding: This work was supported by a grant from Driving out Diabetes: A Larry H. Miller Family Wellness Initiative. Research reported in this work was also supported by the NCI of the NIH under award numbers U01 CA206110, R01 CA189184, and R01 CA207371 (C.M. Ulrich), and P30 CA042014. Research reported in this work utilized the Cancer Biostatistics Shared Resource at the Huntsman Cancer Foundation at the University of Utah. Dr. Holowatyj was supported by the National Human Genome Research Institute of the NIH under Ruth L. Kirschstein National Research Service award number T32 HG008962.

Disclaimer: Driving out Diabetes: A Larry H. Miller Family Wellness Initiative had no role in the design and conduct of the study; the collection, management, analysis, and interpretation of the data; the preparation, review, or approval of the manuscript; and the decision to submit the manuscript for publication. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

Correspondence: Dominik J. Ose, DrPH, MPH, Department of Family and Preventive Medicine, University of Utah, 375 Chipeta Way, Salt Lake City, UT 84108. Email: dominik.ose@hsc.utah.edu

Supplementary Materials

    • Supplemental Materials (PDF 122 KB)
  • 1.

    National Cancer Institute, Division of Cancer Control & Population Sciences. NCI Office of Cancer Survivorship. Accessed September 21, 2020. Available at: https://cancercontrol.cancer.gov/ocs

    • Search Google Scholar
    • Export Citation
  • 2.

    National Diabetes Statistics Report, 2017. Estimates of diabetes and its burden in the United States. Accessed September 21, 2020. Available at: https://dev.diabetes.org/sites/default/files/2019-06/cdc-statistics-report-2017.pdf

    • Search Google Scholar
    • Export Citation
  • 3.

    Giovannucci E, Harlan DM, Archer MC, et al. . Diabetes and cancer: a consensus report. Diabetes Care 2010;33:16741685.

  • 4.

    Zaorsky NG, Shaikh T, Ruth K, et al. . Prostate cancer patients with unmanaged diabetes or receiving insulin experience inferior outcomes and toxicities after treatment with radiation therapy. Clin Genitourin Cancer 2017;15:326335.e3.

    • Search Google Scholar
    • Export Citation
  • 5.

    Raikundalia MD, Fang CH, Spinazzi EF, et al. . Impact of diabetes mellitus on head and neck cancer patients undergoing surgery. Otolaryngol Head Neck Surg 2016;154:294299.

    • Search Google Scholar
    • Export Citation
  • 6.

    Karlin NJ, Kosiorek HE, Castro JC, et al. . Risk of hospitalization in patients with diabetes mellitus who have solid-organ malignancy. Future Sci OA 2016;2:FSO129.

    • Search Google Scholar
    • Export Citation
  • 7.

    Dąbrowski M, Grondecka A. Diabetes as a risk factor of hospitalization in the surgical ward due to cancer in the elderly and middle-aged population. Arch Med Sci 2017;13:10251030.

    • Search Google Scholar
    • Export Citation
  • 8.

    Barone BB, Yeh HC, Snyder CF, et al. . Long-term all-cause mortality in cancer patients with preexisting diabetes mellitus: a systematic review and meta-analysis. JAMA 2008;300:27542764.

    • Search Google Scholar
    • Export Citation
  • 9.

    Barone BB, Yeh HC, Snyder CF, et al. . Postoperative mortality in cancer patients with preexisting diabetes: systematic review and meta-analysis. Diabetes Care 2010;33:931939.

    • Search Google Scholar
    • Export Citation
  • 10.

    Ranc K, Jørgensen ME, Friis S, et al. . Mortality after cancer among patients with diabetes mellitus: effect of diabetes duration and treatment. Diabetologia 2014;57:927934.

    • Search Google Scholar
    • Export Citation
  • 11.

    Hoffman KE, McCarthy EP, Recklitis CJ, et al. . Psychological distress in long-term survivors of adult-onset cancer: results from a national survey. Arch Intern Med 2009;169:12741281.

    • Search Google Scholar
    • Export Citation
  • 12.

    Thong MSY, van de Poll-Franse L, Hoffman RM, et al. . Diabetes mellitus and health-related quality of life in prostate cancer: 5-year results from the Prostate Cancer Outcomes Study. BJU Int 2011;107:12231231.

    • Search Google Scholar
    • Export Citation
  • 13.

    Yabroff KR, Lawrence WF, Clauser S, et al. . Burden of illness in cancer survivors: findings from a population-based national sample. J Natl Cancer Inst 2004;96:13221330.

    • Search Google Scholar
    • Export Citation
  • 14.

    Bowker SL, Pohar SL, Johnson JA. A cross-sectional study of health-related quality of life deficits in individuals with comorbid diabetes and cancer. Health Qual Life Outcomes 2006;4:17.

    • Search Google Scholar
    • Export Citation
  • 15.

    Shin DW, Ahn E, Kim H, et al. . Non-cancer mortality among long-term survivors of adult cancer in Korea: national cancer registry study. Cancer Causes Control 2010;21:919929.

    • Search Google Scholar
    • Export Citation
  • 16.

    Renehan A, Smith U, Kirkman MS. Linking diabetes and cancer: a consensus on complexity. Lancet 2010;375:22012202.

  • 17.

    Vigneri P, Frasca F, Sciacca L, et al. . Diabetes and cancer. Endocr Relat Cancer 2009;16:11031123.

  • 18.

    Tsilidis KK, Kasimis JC, Lopez DS, et al. . Type 2 diabetes and cancer: umbrella review of meta-analyses of observational studies. BMJ 2015;350:g7607.

    • Search Google Scholar
    • Export Citation
  • 19.

    Huang Y, Cai X, Qiu M, et al. . Prediabetes and the risk of cancer: a meta-analysis. Diabetologia 2014;57:22612269.

  • 20.

    Hwangbo Y, Kang D, Kang M, et al. . Incidence of diabetes after cancer development: a Korean national cohort study. JAMA Oncol 2018;4:10991105.

    • Search Google Scholar
    • Export Citation
  • 21.

    Roeyen G, Jansen M, Chapelle T, et al. . Diabetes mellitus and pre-diabetes are frequently undiagnosed and underreported in patients referred for pancreatic surgery. A prospective observational study. Pancreatology 2016;16:671676.

    • Search Google Scholar
    • Export Citation
  • 22.

    Lohmann AE, Ennis M, Taylor SK, et al. . Metabolic factors, anthropometric measures, diet, and physical activity in long-term breast cancer survivors: change from diagnosis and comparison to non-breast cancer controls. Breast Cancer Res Treat 2017;164:451460.

    • Search Google Scholar
    • Export Citation
  • 23.

    Cetin M, Colak R, Bayram F, et al. . High prevalence of diabetes in patients with pancreatic cancer in central Anatolia, Turkey. Diabetes Res Clin Pract 2002;58:97100.

    • Search Google Scholar
    • Export Citation
  • 24.

    Edwards BK, Noone A-M, Mariotto AB, et al. . Annual Report to the Nation on the status of cancer, 1975-2010, featuring prevalence of comorbidity and impact on survival among persons with lung, colorectal, breast, or prostate cancer. Cancer 2014;120:12901314.

    • Search Google Scholar
    • Export Citation
  • 25.

    Paulus YM, Riedel ER, Sabra MM, et al. . Prevalence of diabetes mellitus in patients with newly evaluated papillary thyroid cancer. Thyroid Res 2014;7:7.

    • Search Google Scholar
    • Export Citation
  • 26.

    Karlin NJ, Dueck AC, Cook CB. Cancer with diabetes: prevalence, metabolic control, and survival in an academic oncology practice. Endocr Pract 2012;18:898905.

    • Search Google Scholar
    • Export Citation
  • 27.

    Aggarwal G, Kamada P, Chari ST. Prevalence of diabetes mellitus in pancreatic cancer compared to common cancers. Pancreas 2013;42:198201.

    • Search Google Scholar
    • Export Citation
  • 28.

    Fritz AG, Percy C, Jack A, et al. , eds. International Classification of Diseases for Oncology: ICD-O, 3rd ed, 1st rev. Geneva, Switzerland: World Health Organization; 2013.

    • Search Google Scholar
    • Export Citation
  • 29.

    American Diabetes Association. 2. Classification and diagnosis of diabetes: standards of medical care in diabetes—2019. Diabetes Care 2019;42(Suppl 1):S1328.

    • Search Google Scholar
    • Export Citation
  • 30.

    Agresti A, Coull BA. Approximate is better than “exact” for interval estimation of binomial proportions. The Amer Stat 1998;52:119126.

    • Search Google Scholar
    • Export Citation
  • 31.

    Bluethmann SM, Mariotto AB, Rowland JH. Anticipating the “silver tsunami”: prevalence trajectories and comorbidity burden among older cancer survivors in the United States. Cancer Epidemiol Biomarkers Prev 2016;25:10291036.

    • Search Google Scholar
    • Export Citation
  • 32.

    Roujun C, Yanhua Y, Bixun L. High prevalence of diabetes mellitus and impaired glucose tolerance in liver cancer patients: a hospital based study of 4610 patients with benign tumors or specific cancers. F1000 Res 2016;5:1397.

    • Search Google Scholar
    • Export Citation
  • 33.

    National Cancer Institute, Surveillance, Epidemiology, and End Results Program. Site recode. Accessed September 21, 2020. Available at: https://seer.cancer.gov/siterecode/

    • Search Google Scholar
    • Export Citation
  • 34.

    Garg SK, Maurer H, Reed K, et al. . Diabetes and cancer: two diseases with obesity as a common risk factor. Diabetes Obes Metab 2014;16:97110.

    • Search Google Scholar
    • Export Citation
  • 35.

    Hawkins ML, Blackburn BE, Rowe K, et al. . Endocrine and metabolic diseases among colorectal cancer survivors in a population-based cohort. J Natl Cancer Inst 2020;112:7886.

    • Search Google Scholar
    • Export Citation
  • 36.

    Cho J, Kang D, Hwangbo Y, et al. . Risk of diabetes associated with cancer development—in reply. JAMA Oncol 2019;5:429430.

  • 37.

    Flores-Calderón J, Exiga-Gonzaléz E, Morán-Villota S, et al. . Acute pancreatitis in children with acute lymphoblastic leukemia treated with L-asparaginase. J Pediatr Hematol Oncol 2009;31:790793.

    • Search Google Scholar
    • Export Citation
  • 38.

    Yoshida H, Imamura T, Saito AM, et al. . Protracted administration of L-asparaginase in maintenance phase is the risk factor for hyperglycemia in older patients with pediatric acute lymphoblastic leukemia. PLoS One 2015;10:e0136428.

    • Search Google Scholar
    • Export Citation
  • 39.

    Stamatouli AM, Quandt Z, Perdigoto AL, et al. . Collateral damage: insulin-dependent diabetes induced with checkpoint inhibitors. Diabetes 2018;67:14711480.

    • Search Google Scholar
    • Export Citation
  • 40.

    Tzoulis P, Corbett RW, Ponnampalam S, et al. . Nivolumab-induced fulminant diabetic ketoacidosis followed by thyroiditis. Endocrinol Diabetes Metab Case Rep 2018;2018:18-0111.

    • Search Google Scholar
    • Export Citation
  • 41.

    Godwin JL, Jaggi S, Sirisena I, et al. . Nivolumab-induced autoimmune diabetes mellitus presenting as diabetic ketoacidosis in a patient with metastatic lung cancer. J Immunother Cancer 2017;5:40.

    • Search Google Scholar
    • Export Citation
  • 42.

    Michie CO, Sakala M, Rivans I, et al. . The frequency and severity of capecitabine-induced hypertriglyceridaemia in routine clinical practice: a prospective study. Br J Cancer 2010;103:617621.

    • Search Google Scholar
    • Export Citation
  • 43.

    Feng JP, Yuan XL, Li M, et al. . Secondary diabetes associated with 5-fluorouracil-based chemotherapy regimens in non-diabetic patients with colorectal cancer: results from a single-centre cohort study. Colorectal Dis 2013;15:2733.

    • Search Google Scholar
    • Export Citation
  • 44.

    Milluzzo A, Tumminia A, Vella V, et al. . Short-term adverse effects of anticancer drugs in patients with type 2 diabetes. J Chemother 2019;31:150159.

    • Search Google Scholar
    • Export Citation
  • 45.

    Gallo M, Muscogiuri G, Felicetti F, et al. . Adverse glycaemic effects of cancer therapy: indications for a rational approach to cancer patients with diabetes. Metabolism 2018;78:141154.

    • Search Google Scholar
    • Export Citation
  • 46.

    Lipscombe LL, Fischer HD, Yun L, et al. . Association between tamoxifen treatment and diabetes: a population-based study. Cancer 2012;118:26152622.

    • Search Google Scholar
    • Export Citation
  • 47.

    Yennurajalingam S, Frisbee-Hume S, Palmer JL, et al. . Reduction of cancer-related fatigue with dexamethasone: a double-blind, randomized, placebo-controlled trial in patients with advanced cancer. J Clin Oncol 2013;31:30763082.

    • Search Google Scholar
    • Export Citation
  • 48.

    Wooldridge JE, Anderson CM, Perry MC. Corticosteroids in advanced cancer. Oncology (Williston Park) 2001;15:225234.

  • 49.

    Hwangbo Y, Lee EK. Acute hyperglycemia associated with anti-cancer medication. Endocrinol Metab (Seoul) 2017;32:2329.

  • 50.

    Kwon S, Hermayer KL, Hermayer K. Glucocorticoid-induced hyperglycemia. Am J Med Sci 2013;345:274277.

  • 51.

    Clore JN, Thurby-Hay L. Glucocorticoid-induced hyperglycemia. Endocr Pract 2009;15:469474.

  • 52.

    Goebel J, Valinski S, Hershey DS. Improving coordination of care among healthcare professionals and patients with diabetes and cancer. Clin J Oncol Nurs 2016;20:645651.

    • Search Google Scholar
    • Export Citation
  • 53.

    Piette JD, Kerr EA. The impact of comorbid chronic conditions on diabetes care. Diabetes Care 2006;29:725731.

  • 54.

    Walsh J, Young JM, Harrison JD, et al. . What is important in cancer care coordination? A qualitative investigation. Eur J Cancer Care (Engl) 2011;20:220227.

    • Search Google Scholar
    • Export Citation
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