3.1Cancer and Diabetes
AO Protocol Name:Cancer and Diabetes (generic)
AO Type:Type III
Author: ACM
Introduction:
Cancer and diabetes are both common diseases. A meta-analysis has shown that
there is an increased mortality HR of 1.41 (95% confidence interval [CI], 1.28-1.55)
compared with normoglycemic individuals across all cancer types. There can be
several reasons for this. Cancer patients with diabetes may have increased tumor
cell proliferation and metastases in a physiologic environment of hyperinsulinemia
and hyperglycemia. It is possible that high insulin or insulin-like growth factor levels
may promote cancer cell and tumor growth. Another potential pathway is that acute
exposure to hyperglycemia may increase endothelial cell permeability due to
increased generation of reactive oxidative species and structural changes in the
basement membrane, increasing the likelihood of metastasis.1
Patients with pre-existing diabetes may have poorer response to cancer treatment
along with increased infection risk and intra-operative mortality. Furthermore, the
diagnosis and treatment of cancer may distract both the patient and the health care
team from appropriate management of glycaemia, blood pressure, and lipids,
proven to reduce morbidity and mortality in diabetic adults. Although results are not
consistent, a multidisciplinary approach that includes a diabetes-management team
for the treatment of cancer patients with diabetes may be important for improving
long-term outcomes and decreasing mortality.1,2,3
Patient Referral systems:
Develop pathways for patients with diabetes to request early review by their diabetes
care provider or hospital diabetes team
Time to response:
AOS clinical review and/or telephone advice within 24hours working time
Initial evaluation:
 Patient/family understanding of risk of poorly controlled diabetes while on
steroids/treatment
 Ensure patient has community diabetes support if diabetes less well controlled
 Ensure Previous Oncology Correspondence/contact detail made available
Ongoing management:
 If deterioration in diabetes control early referral to diabetes specialist nurse/team
 If patient taking steroids rationalise whether necessary and/or dose
 On discharge inform patient’s GP practice and diabetes specialist nurse
 Continue to monitor blood glucose level if patient discharged on steroids. This is
essential as diabetes treatment will need to be adjusted as steroids are tapered
or increased.
 Inform treating oncologist and/or site specific team as appropriate
Specialist referral:
 If ongoing difficulties with diabetes control refer to diabetes consultant
References:
1. Barone BB, Yeh HC, Snyder CF, Peairs KS, Stein KB, et al. (2008) Long-term
all-cause mortality in cancer patients with preexisting diabetes mellitus: a
systematic review and meta-analysis. JAMA 300: 2754–2764
2. Levetan CS, Salas JR, Wilets IF, Zumoff B. Impact of endocrine and diabetes
team consultation on hospital length of stay for patients with diabetes. Am J
Med. 1995;99(1):22–28.
3. Keating NL, Zaslavsky AM, Herrinton LJ, Selby JV, Wolf RE, Ayanian JZ.
Quality of diabetes care among cancer survivors with diabetes. Med Care.
2007;45(9):869–875