Patricia M. Verona

Hemoglobin A1c testing alone does not sufficiently identify patients with prediabetes.

Whether hemoglobin A(1c) (HbA(1c)) values are suitable for diagnosing diabetes has been debated. We sought to assess the prevalence of elevated HbA(1c) levels in a prediabetes patient population. Oral glucose tolerance tests and HbA(1c) levels were analyzed for patients entering a diabetes prevention program between January 1, 2007, and September 13, 2009. We calculated the percentage of patients with impaired fasting glucose (IFG) and/or impaired glucose tolerance (IGT) who had HbA(1c) values in the 6.0% to 6.4% range or in the 5.7% to 6.4% range. The mean age of the 242 patients was 62 years; 64.0% were women, and 88.0% were white. Isolated IFG was detected in about 56.2% of patients and combined IFG and IGT in about 37.2%. Only 28.5% of patients had HbA(1c) values in the 6.0% to 6.4% range, whereas 65.3% had values in the 5.7% to 6.4% range. Our data suggest that reliance on HbA(1c) testing alone to identify candidates for a diabetes prevention program would miss a substantial number of eligible patients.

CO-EXISTING PROSTATE CANCER AND DIABETES MELLITUS: IMPLICATIONS FOR PATIENT OUTCOMES AND CARE

OBJECTIVE To investigate how diabetes mellitus (DM) impacts short-term overall survival (OS) for patients with prostate cancer and to examine how prostate cancer impacts glycemic control in DM. METHODS Patients with DM and prostate cancer newly diagnosed from 2007 to 2014 were identified from the institutional cancer registry and matched to patients with prostate cancer but no DM according to age and year of prostate cancer diagnosis. RESULTS The study included 276 cases and 276 controls; the mean age was 72 years, most (93%) were white, the most common Gleason score (52%) was 7, and the majority (56%) were tumor stage II. Patients with DM had a higher mean body mass index (P = .03). Alcohol use and performance status differed by group (P<.001), but the 2 groups otherwise were not significantly different. Among those with DM, the mean hemoglobin A1c (HbA1c) was 6.7%. In Kaplan-Meier survival analysis (median follow-up time, 43.7 months), the 5-year OS rates were estimated at 88% and 93% for patients with and without DM, respectively (hazard ratio, 1.64; 95% confidence interval, 0.77-3.46; P = .20). Mean glucose among patients with DM was significantly higher (P<.001) compared with non-DM patients, but mean HbA1c and glucose values did not change significantly over 1 year (P≥.13). CONCLUSION DM did not adversely impact survival in patients with prostate cancer. In addition, prostate cancer and its treatment did not affect glycemic control. Patients and their providers can be reassured that the concurrent diagnoses do not adversely interact to worsen short-term outcomes. ABBREVIATIONS DM = diabetes mellitus; HbA1c = hemoglobin A1c; OS = overall survival.

An outpatient-based clinical program for diabetes prevention: an update.

OBJECTIVE To update outcomes of the Diet-Exercise-Activity-Lifestyle (DEAL) program, a clinic-based diabetes prevention intervention. METHODS Changes in weight, fasting blood glucose, and 2-hour glucose after a 75-g oral glucose tolerance test were evaluated in patients who enrolled in the DEAL program between January 2007 and August 2009. RESULTS The 221 qualified participants had a mean age of 62 years, weight of 87.4 kg, body mass index of 31.2 kg/m², fasting glucose level of 109 mg/dL, and 2-hour glucose value of 138 mg/dL. Among the program participants, 67% were women and 88% were white; 56% had isolated impaired fasting glucose, 5% had impaired glucose tolerance only, and 39% had both. The 6-month follow-up medical appointment was kept by 72% of program participants, but only 56% attended the 12-month visit. By 6 months after baseline, 59% had significantly lower fasting glucose concentrations, 59% had improvement in 2-hour glucose levels, and 61% had weight loss. Nearly 40%, however, were nonresponders and had increased fasting glucose, 2-hour glucose, and weight by 6 months. By the 12-month visit, significant declines in fasting glucose (P<.001), 2-hour glucose (P<.001), and weight (P = .008) occurred in comparison with baseline values; however, no significant changes occurred in these measures between the 6- and 12-month visits (P>.30 for all). CONCLUSION Most DEAL participants showed improvement in glucose levels and weight, but some patients exhibited worsening glucose intolerance. Factors underlying nonresponse need to be identified. Ongoing experience and analysis should help revise the DEAL program so that outcomes for all participating patients will improve.

Patient outcomes from lung cancer and diabetes mellitus: a matched case–control study

Aim: This case–control study examined the impact of diabetes mellitus (DM) on survival in lung cancer patients and lung cancer on glycemic control in DM. Materials & methods: Patients with a new lung cancer diagnosis and DM (n = 124) were matched to 124 lung cancer patients without DM. Laboratory results and DM and cancer therapies were obtained from electronic records. Results: Five-year overall survival for lung cancer patients with and without DM was 20 versus 29% (p = .12). Glycemic control among DM patients did not change significantly with time. Conclusion: DM does not cause adverse impact on lung cancer survival. Lung cancer does not affect glycemic control.

Survival and glycemic control outcomes among patients with coexisting pancreatic cancer and diabetes mellitus

Aim: We aimed to determine the effect of diabetes mellitus (DM) on survival in pancreatic cancer and effects of pancreatic cancer on glycemic control in DM. Materials & methods: Patients with pancreatic cancer from 2007 to 2015, with and without DM, were matched 1:1. We compared characteristics between the groups and assessed 2-year survival with Kaplan–Meier analysis. Results: In patients with DM, hemoglobin A1c decreased significantly over time (p = 0.01). In survival analysis, 2-year overall survival estimates were 15% (95% CI: 8–24%) for DM patients versus 26% (95% CI: 17–36%) for non-DM patients (p = 0.55). The hazard ratio for matched pairs was 1.15 (95% CI: 0.75–1.77; p = 0.51). Conclusion: DM did not decrease survival in pancreatic cancer. Pancreatic cancer did not affect glycemic control.

Survival and glycemic control in patients with colorectal cancer and diabetes mellitus

Aim: The impact of diabetes mellitus (DM) on survival in patients with colorectal cancer and the impact of colorectal cancer on glycemic control were examined. Materials & methods: Patients with colorectal cancer with and without DM were matched 1:1 (2007–2015). Characteristics were compared between the two groups and survival assessed with the Kaplan–Meier method. Mixed models compared hemoglobin A1c and glucose levels over time. Results: In both groups, glucose values decreased during the year following cancer diagnosis (p < 0.001). 5-year overall survival was 56% (95% CI: 42–68%) for DM patients versus 57% (95% CI: 43–69%) for non-DM patients (p = 0.62). Conclusion: DM did not adversely impact survival of patients with colorectal cancer. Colorectal cancer did not affect glycemic control.

Breast cancer patients with diabetes mellitus: Defining the population and assessing outcomes.

137 Background: Diabetes has been associated with an increased risk of mortality among patients with many types of cancers. METHODS We performed a case-control study of 109 breast cancer patients to determine the impact of diabetes on disease recurrence and survival. These 109 patients diagnosed with invasive breast cancer during 2007-2011 with diabetes were identified from the institutional Cancer Registry and matched to 109 breast cancer patients without diabetes according to age, race/ethnicity and year of diagnosis. Statistical tests included paired t-tests, McNemars tests, and stratified Cox regression. RESULTS The median ages of those with and without diabetes were 68 years, and 91% in both groups were white (both matched). Patients with and without diabetes were not significantly different in terms of tumor grade, cancer stage, estrogen or progesterone receptor status, HER2 neu status, marital and employment status, smoking use, use of adjuvant chemotherapy, and steroid treatment (all P >.4). Patients with diabetes reported less use of alcohol (50% vs 64%, P=.04), and had greater BMI (79% overweight/obese vs 58%, P= .002). Survival analysis demonstrated no differences in survival from initial breast cancer diagnosis (HR=1.25, 95% CI 0.49-3.17) with median follow-up of 2.2 years (range 0.1-4.9), and no differences in recurrence-free survival (HR=1.00, 95% CI 0.14-7.10) though very few deaths and recurrences were observed. Within the diabetes group, 96 (88%) had type 2 diabetes and 97/106 (92%, 3 unknown) had diabetes pre-existing to cancer diagnosis. Initial diabetes therapy included diet (33, 30%), oral therapy (48, 44%), insulin (21, 19%), or oral+insulin (6, 6%). 7 patients required a change in diabetes therapy within 1 year of cancer diagnosis with 3 patients starting insulin. 32/70 (46%) with available lab data had 1 or more A1C >/=7 within 1 year of cancer diagnosis. CONCLUSIONS In this retrospective, carefully matched case-control study, we developed a comprehensive profile of the patient population with newly diagnosed breast cancer and diabetes. Diabetes did not appear to impact mortality or recurrence-free survival based on descriptive estimates in this small breast cancer cohort.