Understanding the Prevalence of Prediabetes and Diabetes in Patients With Cancer in Clinical Practice: A Real-World Cohort Study
Huntsman Cancer Institute, and
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Department of Population Health Sciences, School of Medicine, Salt Lake City, Utah;
Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee; and
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Department of Population Health Sciences, School of Medicine, Salt Lake City, Utah;
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Department of Population Health Sciences, School of Medicine, Salt Lake City, Utah;
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Department of Population Health Sciences, School of Medicine, Salt Lake City, Utah;
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Huntsman Cancer Institute, and
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Department of Population Health Sciences, School of Medicine, 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.
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