Abstract
BackgroundCancer and Diabetes Mellitus (DM) are leading causes of death worldwide and the prevalence of both is escalating. People with co-morbid cancer and DM have increased morbidity and premature mortality compared with cancer patients with no DM. The reasons for this are likely to be multifaceted but will include the impact of hypo/hyperglycaemia and diabetes therapies on cancer treatment and disease progression. A useful step toward addressing this disparity in treatment outcomes is to establish the impact of cancer treatment on diabetes control.AimThe aim of this review is to identify and analyse current evidence reporting glycaemic control (HbA1c) during and after cancer treatment.MethodsSystematic searches of published quantitative research relating to comorbid cancer and type 2 diabetes mellitus were conducted using databases, including Medline, Embase, PsychINFO, CINAHL and Web of Science (February 2017). Full text publications were eligible for inclusion if they: were quantitative, published in English language, investigated the effects of cancer treatment on glycaemic control, reported HbA1c (%/mmols/mol) and included adult populations with diabetes. Means, standard deviations and sample sizes were extracted from each paper; missing standard deviations were imputed. The completed datasets were analysed using a random effects model. A mixed-effects analysis was undertaken to calculate mean HbA1c (%/mmols/mol) change over three time periods compared to baseline.ResultsThe available literature exploring glycaemic control post-diagnosis was mixed. There was increased risk of poor glycaemic control during this time if studies of surgical treatment for gastric cancer are excluded, with significant differences between baseline and 12 months (p < 0.001) and baseline and 24 months (p = 0.002).ConclusionWe found some evidence to support the contention that glycaemic control during and/or after non-surgical cancer treatment is worsened, and the reasons are not well defined in individual studies. Future studies should consider the reasons why this is the case.
Highlights
Incidence of diabetes mellitus (DM) continues to grow worldwide with 415 million estimated cases in 2015 and figures are predicted to reach 642 million by 2040 [1]
The aim of this review is to identify and analyse current evidence reporting glycaemic control (HbA1c) during and after cancer treatment
Full text publications were eligible for inclusion if they: were quantitative, published in English language, investigated the effects of cancer treatment on glycaemic control, reported HbA1c (%/mmols/mol) and included adult populations with diabetes
Summary
Incidence of diabetes mellitus (DM) continues to grow worldwide with 415 million estimated cases in 2015 and figures are predicted to reach 642 million by 2040 [1]. There is growing evidence that for individuals with DM, the risk of developing cancer significantly increases when compared to a non-diabetic population [3,4,5]. Consequences include: increased mortality [7,8], higher infection rates [9,10], higher hospitalisation rates [10], worse physical function [11] and poorer prognosis [12,9] Potential reasons for these poorer outcomes include: prioritising cancer treatments over DM self-management activities [11,13]; increased prevalence of and/or under recognition of hyperglycaemia [14]; and clinicians lacking skills in managing both these complex conditions [14,15]. A useful step toward addressing this disparity in treatment outcomes is to establish the impact of cancer treatment on diabetes control
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