Diabetes Self-Management among Cancer Survivors: Differences by Diagnosis and Treatment

Abstract

Increasing evidence suggests that individuals may neglect some of their non-oncologic care, especially related to diabetes, after a cancer diagnosis. As mortality from cancer has been declining, the importance of optimal diabetes management is increasingly important, as many patients have prolonged survivorship periods. We aimed to conduct a comprehensive cross-sectional survey to assess rates of diabetes self-management among recently treated cancer patients across the survivorship continuum at our institution. Further, we aimed to assess the extent to which self-management behaviors of cancer patients at our institution differed from the general population, and if these behaviors varied by site, treatment, stage or race. With IRB approval, diabetic patients who were treated for any malignancy at our institution from 2012-2018 were contacted to complete a survey of subjective and objective measures of diabetic compliance (including hemoglobin A1c and subjective diabetic control). Demographic and clinical factors such as stage, site, and treatment modality were abstracted from medical records. Rates of diabetic control were compared with adults in the Health and Retirement Survey Diabetes Supplement, which was a large survey of diabetic adults in the US. Finally, t-tests and Fisher Exact Tests were used to clarify the extent to which these outcomes varied with and demographic and oncologic factors. A total 68 patients consented to the survey. Most patients were those with cancers of the breast (n=15), GI tract (n=15) or GU sites (n=11), and 33 patients (49%) received radiotherapy. Most patients (85%) were stage II or lower. A total of 75% of patients were white and 21% African American. Overall compliance with recommended diabetes management activities, including yearly HbA1c checks, medication compliance, and annual eye exams was excellent, at 95%, 88%, and 84%, respectively. More than 75% reported HbA1c values of 7% or below. Self-reported diabetes control (rated from 1-5 with 5 being best control) averaged 3.19. There was no difference in diabetes control among surveyed patients compared to the rates described in the overall US diabetic population. Further, there was no relationship between age, treatment modality, years since diagnosis, cancer site, or measures of diabetes control. However, African American patients had higher average reported HbA1c compared to their white counterparts, and were less likely to be compliant with medications (60%) compared to white patients (95%) (p<0.05). Overall rates of self-reported control and compliance among diabetic cancer survivors treated at our institution were very high, with no substantially variations by disease site, time since treatment, or stage. African American survivors had higher HbA1c rates and medication noncompliance compared to their white counterparts. Increased awareness of diabetes management in this population may be warranted.