Abstract
BackgroundSurvival from many cancer types is steadily increasing, and as a result, a growing number of cancer patients will live with other chronic diseases, of which diabetes is one of the most prevalent. This study aims 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.MethodsThe randomized controlled trial Diabetes Care in General Practice (DCGP) included 1381 patients newly diagnosed with type 2 diabetes. Patients were randomized to either six years of structured personal diabetes care or routine care. In a post hoc analysis, we followed patients for 19 years in Danish national registries for the occurrence of diabetes-related outcomes. We used Cox regression models to estimate hazard ratios for outcomes.ResultsAt diagnosis 48 patients had cancer, and 243 patients were diagnosed with cancer during follow up. Patients with diabetes and cancer had excess all-cause mortality (HR 3.33; 95%CI 2.72–4.06), as well as 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). The intervention reduced the risk of both these endpoints in patients without cancer. Furthermore, there was no statistically significant difference in the effectiveness of the intervention among patients with and without cancer.ConclusionsDiabetes patients with cancer had an increased risk of myocardial infarction and any diabetes-related outcome. The observed positive effect of structured personal diabetes care on clinical outcomes did not differ between patients with and without cancer. Attention to and prevention of diabetes complications in patients with both type 2 diabetes and cancer is warranted.Trial registrationClinicalTrials.gov NCT01074762 (February 24, 2010).
Highlights
Survival from many cancer types is steadily increasing, and as a result, a growing number of cancer patients will live with other chronic diseases, of which diabetes is one of the most prevalent
COPD and CVD is less common in patients who have completed primary cancer treatment compared to patients with no cancer [8,9,10,11], Arreskov et al BMC Endocrine Disorders (2019) 19:60 implying that for cancer patients with diabetes, both mortality and incidence of complications are increased compared to cancer patients without diabetes [12, 13]
Levels of many of the clinical characteristics in these 67 patients (e.g., HbA1c and blood pressures) was similar to those of the whole study population [16, 17] (Tables 1 and 2). This indicates that the effect of the intervention on intermediate outcomes was similar for patients with and without concomitant cancer
Summary
Survival from many cancer types is steadily increasing, and as a result, a growing number of cancer patients will live with other chronic diseases, of which diabetes is one of the most prevalent. This study aims 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. A growing number of patients with cancer will live with other chronic diseases, of which diabetes is one of the most prevalent [2]. The management of diabetes in cancer patients is often complicated [6, 7]. The diagnosis and treatment of cancer may distract both patients, and health care providers form the appropriate management of diabetes. COPD and CVD is less common in patients who have completed primary cancer treatment compared to patients with no cancer [8,9,10,11], Arreskov et al BMC Endocrine Disorders (2019) 19:60 implying that for cancer patients with diabetes, both mortality and incidence of complications are increased compared to cancer patients without diabetes [12, 13]
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