Undiagnosed Diabetes in Breast, Colorectal, Lung, and Prostate Cancer: Incidence and Risk Factors

Abstract

Our study describes the incidence and risk factors for undiagnosed diabetes in elderly cancer patients. Using Surveillance, Epidemiology, and End Results-Medicare data, we followed patients with breast, colorectal, lung, or prostate cancer from 24 months before to 3 months after cancer diagnosis. Medicare claims were used to exclude patients with diabetes 24 to 4 months before cancer (look-back period), identify those with diabetes undiagnosed until cancer, and construct indicators of preventive services, physician contact, and comorbidity during the look-back period. Logistic regression analyses were performed to identify factors associated with undiagnosed diabetes. Overall, 2,678 patients had diabetes undiagnosed until cancer. Rates were the highest in patients with both advanced-stage cancer and low prior primary care/medical specialist contact (breast 8.2%, colorectal 5.9%, lung 4.4%). Nonwhite race/ethnicity, living in a census tract with a higher percent of the population in poverty and a lower percent college educated, lower prior preventive services use, and lack of primary care and/or medical specialist care prior to cancer all were associated with higher (P ≤ 0.05) adjusted odds of undiagnosed diabetes. Undiagnosed diabetes is relatively common in selected subgroups of cancer patients, including those already at high risk of poor outcomes due to advanced cancer stage.

A systematic review of genetic ancestry as a risk factor for incidence of non-small cell lung cancer in the US

“…Increased pollution in metropolitan areas may also play a role in risk of developing NSCLC ( Ahn et al, 2013 ). Due to this variability, geographic location can also influence risk of NSCLC incidence in AAs, CAs, and HAs ( Griffiths et al, 2014 ).…”

“…Comorbidities are another lifestyle factor that may influence NSCLC risk, incidence, and adverse health outcomes in NSCLC patients. Several comorbidities associated with worse survival outcomes in NSCLC patients include myocardial infarction, congestive heart failure, diabetes with and without complications, and chronic pulmonary disease ( Griffiths et al, 2014 ). In a study conducted by Ahn et al (2013) , the Charlson Comorbidity Index was used to evaluate the influence of medical comorbidities on NSCLC outcomes by stage.…”

“…In a study conducted by Ahn et al (2013) , the Charlson Comorbidity Index was used to evaluate the influence of medical comorbidities on NSCLC outcomes by stage. The Charlson Comorbidity Index is a measure of the degree of association between 19 different chronic diseases including the examples mentioned above, and their association with mortality ( Griffiths et al, 2014 ).…”

“…HIV was also highlighted as an independent risk factor for incident lung cancer, as it is considered the most common cancer diagnosed among patients that also have HIV ( Sigel et al, 2012 ; Ahn et al, 2013 ; Griffiths et al, 2014 ). The study suggested that this higher incidence rate of lung cancer among HIV patients is potentially driven by deficiencies in the physiological functions of the immune system as a result of HIV incidence ( Williams et al, 2013 ).…”

A nurse‐led intervention in patients with newly diagnosed cancer and Type 2 diabetes: A pilot randomized controlled trial feasibility study

“…One way to improve identification of future patients would be to integrate HbA1c testing into order sets for all newly diagnosed cancer patients entering the clinic and broaden the eligibility criteria to a more pragmatic assessment of clinical acceptability for metformin use, rather than only including those with laboratory values within normal limits. This area of research is important because undiagnosed diabetes prior to cancer diagnosis may deteriorate blood glucose level and cause poor prognosis due to difficulty of co‐managing both comorbidity and low healthcare provider contact 11,12 . It is also associated with higher mortality 3 .…”