Inpatient Diabetes Mellitus in the Oncology Setting

The complex dual diagnosis of diabetes and cancer

Diabetes and cancer are two of the top three killers in the United States. As the number of people surviving cancer increases, more patients will be living with both cancer and diabetes. This integrative review of the literature will provide an overview of diabetes, cancer, and the complex interactions between the two. A literature search was conducted and three main areas were identified that warrant additional discussion: the relationship between glucocorticoids and hyperglycemia, glucose control in the management of diabetes in patients with cancer, and an increased risk of certain cancers with the comorbid condition of diabetes. The hope is that, through additional research, evidence-based practice guidelines can be developed to direct the care of these challenging comorbid conditions. To provide holistic care to patients, diabetes and cancer management must be incorporated into healthcare curricula and should be an essential part of clinical diabetes educator certification.

Cancer risk among patients hospitalized for Type 1 diabetes mellitus: a population-based cohort study in Sweden

AIMS

Type 1 diabetes mellitus (T1DM) is an autoimmune disease with potential mechanistic links to immune-related cancers. We aimed at examining the overall and specific cancer risks among hospitalized T1DM patients from the national registers in Sweden.

METHODS

A T1DM research cohort was created by identifying T1DM patients from the Hospital Discharge Register and linking them with the Cancer Registry. Standardized incidence ratios (SIRs) for subsequent cancers were calculated among patients with T1DM compared with those without T1DM.

RESULTS

Two hundred and fifty-eight cases were ascertained with subsequent cancers during the follow-up duration from 1964 to 2006, with an increased overall SIR of 1.17 (95% CI 1.04-1.33) among 24 052 T1DM patients identified at baseline. Significant excess was noted for gastric and skin (squamous cell carcinoma) cancers and for leukaemia. Increased risk of acute lymphatic leukaemia accounted for most of the variation of leukaemia risk (SIR = 5.31, 95% CI 3.32-8.05). Cancer risk varied with sex, age at first hospitalization and numbers of hospitalizations. The risk was higher in women compared with men and in those hospitalized for T1DM at age over 10 years compared with the younger patients. Higher risks were also found among those with more hospital visits.

CONCLUSION

By quantifying the variations of overall and site-specific cancer risks after T1DM, the current study provides novel associations between T1DM and subsequent cancers, the mechanisms of which remain to be established.

Diabetes management and self-care education for hospitalized patients with cancer

Managing diabetes can be a daunting task for patients with cancer. Empowerment-based diabetes education and motivational interviewing are complementary approaches. Oncology nurses may feel unprepared to teach patients and their families about self-care for diabetes, but they provide individualized information on symptom management of cancer throughout hospitalization and at discharge. The essential self-care issues include food, exercise, medication, blood glucose monitoring, prevention, recognition and treatment of hypoglycemia and hyperglycemia, and when and how to get additional medical and educational support. This patient-centered model of diabetes education differs from the older "compliance" model that covers many universal rules for all patients, which are predetermined by the nurse. Informing nurses about their role in care of patients with cancer and diabetes is critical.