Type 2 diabetes and cancer: problems and suggestions for best patient management

Milluzzo, Agostino; Vigneri, Paolo; Martorana, Federica; Vigneri, Riccardo; Sciacca, Laura

doi:10.37349/emed.2020.00013

Cited by 14 publications

(7 citation statements)

References 142 publications

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“…The goal to prevent diabeticrelated macrovascular and microvascular complications might not be as important in those with life-limiting diagnoses such as cancer. HbA1c between 8-9% and glycemic values between 7 to 15 mmol/L are reasonable in this kind of patient [13].…”

Section: Discussionmentioning

confidence: 51%

Recurrent hypoglycemia in a patient with hepatocellular carcinoma

2023

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Hypoglycemia is a common complication of diabetes mellitus. Patients may present with any kind of symptoms, either autonomic or neuroglycopenic. Here, we report a case of a 70-year-old man with type 2 diabetes mellitus with a newly diagnosed hepatocellular carcinoma presenting with recurrent episodes of hypoglycemia. The insulin treatment was withheld initially. However, the patient's diabetic control worsened after starting treatment for his hepatocellular carcinoma. Hence, the insulin treatment was resumed. This case highlighted the challenge in balancing the management of hypoglycaemia and poor diabetic control in a patient who has diabetes mellitus and hepatocellular carcinoma. Primary care practitioners need to have high clinical suspicion to monitor these patients to prevent hypoglycemia and manage them accordingly.

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Section: Discussionmentioning

confidence: 51%

Recurrent hypoglycemia in a patient with hepatocellular carcinoma

2023

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“…54,55,57 Integrated, shared, and coordinated clinical care pathways are novel approaches that hold great potential in overcoming the health disparities in this patient population by (a) increasing communication and coordination between oncology and endocrinology HCPs/teams, (b) taking all diabetes and oncology-related treatment options into consideration and developing tailored treatment plans for patients, (c) sharing evidence-based clinical resources and tools, and (d) educating care teams and patients on the dual disease management by understanding how these diseases interact, the importance of diabetes self-management, and the ability to recognize and address common adverse outcomes/complications. 54,55,[58][59][60] Such integrated, shared, and coordinated clinical care pathways have the potential to optimize health care services expenditure and optimize patient outcomes and quality of life, as evidence from preliminary reports, 54,55 but, further examination of such interventions is warranted. 61 The second implication is the development of evidence-based clinical guidelines and policies for the concurrent management of diabetes and cancer.…”

Section: Discussionmentioning

confidence: 99%

Influence of Diabetes Mellitus on Oncological Outcomes for Patients Living With Cancer

Murphy

Sherifali

Ali

et al. 2023

The Science of Diabetes Self-Management and Care

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Purpose The purpose of this meta-analysis was to examine the association between preexisting diabetes in persons living with cancer on diabetes and oncology-related health outcomes. Understanding this association is of priority because the incidence of both cancer and diabetes mellitus is increasing worldwide. Methods A comprehensive review of the literature was conducted in collaboration with an expert health sciences librarian. Two authors independently conducted the screening, data collection, and extraction processes. The risk of bias was assessed using several tools, depending on the study design. Relative risks with 95% confidence intervals were calculated. The alpha threshold was 0.05. All analyses were performed using R statistical software (Metaphor and Demeter packages). Results A total of 45 studies met the selection criteria, but 23 were excluded from the synthesis because they did not have the ranked outcome or correct comparison (persons with and without diabetes), totaling 22 studies included in the meta-analysis. In comparison to participants without preexisting diabetes, participants with preexisting diabetes and cancer were found to have a significantly higher risk of infection and cardiovascular, neurological, gastrointestinal, hepatic, and renal complications. Concurrent preexisting diabetes and cancer were also associated with increased health care service utilization and length of hospital stay. Conclusion The findings from this review highlight the importance of optimal concurrent management of both diseases by overcoming the compartmentalization of medical specializations through (1) integrated, multidisciplinary, shared, and coordinated clinical care pathways between oncology and diabetes health care providers/teams and (2) the continued development of evidence-based clinical guidelines.

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“…Approximately 30% of people with T2D may require insulin therapy during the course of disease [17,18], sometimes also due to intercurrent diseases. Most people with T2D requiring insulin therapy are cared for by primary healthcare practitioners who have usually not much knowledge of CSII compared with trained diabetes team [13].…”

Section: Csii and T2dmentioning

confidence: 99%

Insulin pump therapy and continuous glucose monitoring in adults with type 2 diabetes: where are we now?

Pedone

Laurenzi

Allora

et al. 2020

Exploration of Medicine

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Technology in diabetes is rapidly evolving, with the aim of helping affected people to safely optimize their blood glucose control. New technologies are now considered as an essential tool for managing glycemia predominantly in people with type 1 diabetes, and clinical trials have demonstrated that in these subjects the use of continuous subcutaneous insulin infusion (CSII) and continuous glucose monitoring (CGM) systems are associated with improved glycemic control along with a better quality of life. Literature regarding technologies and type 2 diabetes is relatively lacking, but innovations may have an important role also in the management of these patients. Some studies in adults with type 2 diabetes have shown benefits with the use of CGM in terms of glycemic variability and improved therapeutic adjustments. Clinical trials about CSII and CGM use in type 2 diabetes may have some pitfalls and future studies are needed to assess how these advanced systems could improve clinical outcomes and also ensure cost-effectiveness in this population. In this narrative review, we aim to highlight the most relevant studies on this topic and to focus on the potential role of new technological devices in type 2 diabetes management.

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Type 2 diabetes and cancer: problems and suggestions for best patient management

Cited by 14 publications

References 142 publications

Recurrent hypoglycemia in a patient with hepatocellular carcinoma

Recurrent hypoglycemia in a patient with hepatocellular carcinoma

Influence of Diabetes Mellitus on Oncological Outcomes for Patients Living With Cancer

Insulin pump therapy and continuous glucose monitoring in adults with type 2 diabetes: where are we now?

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