The impact of cancer on diabetes outcomes.

Publisher: BioMed Central Country of Publication: England NLM ID: 101088676 Publication Model: Electronic Cited Medium: Internet ISSN: 1472-6823 (Electronic) Linking ISSN: 14726823 NLM ISO Abbreviation: BMC Endocr Disord Subsets: MEDLINE

Original Publication: London : BioMed Central, [2001-

Early Medical Intervention*; Diabetes Mellitus, Type 2/*epidemiology ; General Practice/*statistics & numerical data ; Myocardial Infarction/*epidemiology ; Neoplasms/*complications; Aged ; Denmark/epidemiology ; Diabetes Mellitus, Type 2/etiology ; Diabetes Mellitus, Type 2/therapy ; Female ; Follow-Up Studies ; Humans ; Incidence ; Male ; Middle Aged ; Myocardial Infarction/etiology ; Myocardial Infarction/therapy ; Prognosis ; Registries

Background: 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.
Methods: The 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.
Results: At 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.
Conclusions: Diabetes 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 Registration: ClinicalTrials.gov NCT01074762 (February 24, 2010).

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Keywords: All-cause mortality; Cancer; Diabetes care; Diabetes complication; Primary care; Randomized controlled trial; Type 2 diabetes

ClinicalTrials.gov NCT01074762

Date Created: 20190613 Date Completed: 20191206 Latest Revision: 20200225

20231215

PMC6560822

10.1186/s12902-019-0377-0

31185995