No votes yet

The Complex Dual Diagnosis of Diabetes and Cancer

Crystal Stevens
Shirley Dinkel
Jeanne Catanzaro
CJON 2011, 15(6), 654-658 DOI: 10.1188/11.CJON.654-658

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.


American Cancer Society. (2010). The global economic cost of cancer. Retrieved from <a target="_blank" href='http://www.cancer.org/acs/groups/content/@internationalaffairs/documents...@internationalaffairs/documents/document/acspc-026203.pdf</a>

American Cancer Society. (2011). <i>Cancer facts and figures 2011.</i> Retrieved from <a target="_blank" href='http://www.cancer.org/acs/groups/content/@epidemiologysurveilance/docume...@epidemiologysurveilance/documents/document/acspc-029771.pdf</a>

American Diabetes Association. (2011). Diabetes basics: Diabetes statistics. Retrieved from <a target="_blank" href='http://www.diabetes.org/diabetes-basics/diabetes-statistics/?utm_source=...

Appleman, L. J., Tzachanis, D., Grader-Beck, T., Van Puijenbroek, A. A., & Boussiotis, V. A. (2001). Helper t cell anergy: From bio-chemistry to cancer pathophysiology and therapeutics. <i>Journal of Molecular Medicine, 78</i>, 673-683. doi:10.1007/s001090000180

Bloomgarden, Z. T. (2007). Diabetic retinopathy and diabetic neuropathy. <i>Diabetic Care, 30</i>, 760-765. doi:10.2337/dc07-zb03

Boyle, P. J. (2007). Diabetes mellitus and macrovascular disease: Mechanisms and mediators. <i>American Journal of Medicine, 120</i>(9B), S12-S17. doi:10.1016/j.amjmed.2007.07.003

Brauer, P. M., McKeown-Eyssen, G. E., & Jazmaji, V. (2002). Familial aggregation of diabetes and hypertension in a case-control study of colorectal neoplasia. <i>American Journal of Epidemiology, 156</i>, 702-713. doi:10.1093/aje/kwf112

Buttaro, T. M., Trybulski, J., Bailey, P. P., & Sandberg-Cook, J. (2003). <i>Primary care: A practice</i> (2nd ed.). St. Louis, MO: Mosby.

Centers for Disease Control and Prevention. (2011a). Cancer prevention and control. Retrieved from <a target="_blank" href='http://www.cdc.gov/cancer/dcpc/data/women.htm'>http://www.cdc.gov/cancer...

Centers for Disease Control and Prevention. (2011b). <i>National diabetes fact sheet.</i> Retrieved from <a target="_blank" href='http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2011.pdf'>http://www.cdc.gov/d...

Coughlin, S. S., Calle, E. E., Teras, L. R., Petrelli, J., & Thun, M. J. (2004). Diabetes mellitus as a predictor of cancer mortality in a large cohort of US adults. <i>American Journal of Epidemiology, 159</i>, 1160-1167. doi:10.1093/aje/kwh161

Engelgau, M. M., Geiss, L. S., Saaddine, J. B., Boyle, J. P., Benjamin, S. M., Gregg, E. W., … Naravan, K. M. (2004). The evolving diabetes burden in the United States. <i>Annals of Internal Medicine, 140</i>, 945-950.

Extermann, M. (2007). Interaction between comorbidity and cancer. <i>Cancer Control, 14</i>, 13-22.

Eyre, H., Kahn, R., & Robertson, R. M. (2004). Preventing cancer, cardiovascular disease, and diabetes. <i>Circulation, 109</i>, 3244-3255.

Ferri, F. F. (2008). <i>Ferri's clinical advisor instant diagnosis and treatment.</i> Philadelphia, PA: Elsevier Mosby.

Goodwin, P. J., Ennis, M., Pritchard, K. I., Trudeau, M. E., Koo, J., Madarnas, Y., … Hood, N. (2002). Fasting insulin and outcomes in early-stage breast cancer: Results of a prospective cohort study. <i>Journal of Clinical Oncology, 20</i>, 42-51. doi:10.1200/JCO.20.1.42

Guthrie, R. A., & Guthrie, D. W. (2004). Pathophysiology of diabetes mellitus. <i>Critical Care Nursing Quarterly, 27</i>(2), 113-125.

Huether, S. E., & McCance, K. L. (2003). <i>Understanding pathophysiology</i> (3rd ed.). St. Louis, MO: Mosby.

Kilpatrick, E. S., Rigby, A. S., & Atkins, S. L. (2006). The effects of glucose variability on the risk of microvascular complications of type 1 diabetes. <i>Diabetes Care, 29</i>, 1486-1490.

Krentz, A. J., Clough, G., & Byrne, C. D. (2007). Interaction between microvascular and macrovascular disease in diabetes: Patho-physiology and therapeutic implications. <i>Diabetes, Obesity, and Metabolism, 9</i>, 781-791. doi:10.1111/j.1463-1326.2007.00670.x

Mazzone, T. (2007). Prevention of macrovascular disease in patients with diabetes mellitus: Opportunities for intervention. <i>American Journal of Medicine, 120</i>(9B), S26-S32.

Meyerhardt, J. A., Catalano, P. J., Haller, D. G., Mayer, R. J., Macdonald, J. S., Benson, A. B., & Fuchs, C. S. (2003). Impact of diabetes mellitus on outcomes in patients with colon cancer. <i>Journal of Clinical Oncology, 21</i>, 433-440. doi:10.1200/JCO.2003.07.125

Nguyen, T. T., Wang, J. J., & Wong, T. Y. (2007). Retinal vascular changes in pre-diabetes and pre-hypertension. <i>Diabetes Care, 30</i>, 2708-2714. doi:10.2337/dc07-0732

Oyer, D. S., Shah, A., & Bettenhausen, S. (2006). <i>How to manage steroid diabetes in the patient with cancer.</i> Retrieved from <a target="_blank" href='http://www.supportiveoncology.net/journal/articles/0409479.pdf'>http://w...

Patti, M. E. (2004). Gene expression in humans with diabetes and pre-diabetes: What have we learned about pathophysiology? <i>Current Opinion in Clinical Nutrition and Metabolic Care, 7</i>, 383-390.

Ratner, R. E. (2003). Pathophysiology of the diabetes disease state. <i>Diabetes and Complications, 5</i>, 3-15.

Redig, A. J., & Munshi, H. G. (2010). Metabolic syndrome after hormone-modifying therapy: Risk associated with antineoplastic therapy. <i>Oncology, 24</i>, 839-844.

Schwab, N., & Porter, M. (2007). Inpatient diabetes mellitus in the oncology setting. <i>Clinical Journal of Oncology Nursing, 11</i>, 489-492.

Singer, M. (2007). Management of co-morbid diabetes and cancer. <i>Oncology, 21</i>(8, Suppl.), 26-37.

Umpierrez, G. E., Isaacs, S. D., Bazargan, N., You, X., Thaler, L. M., & Kitabchi, A. E. (2002). Hyperglycemia: An independent marker of in-hospital mortality in patients with undiagnosed diabetes. <i>Journal of Clinical Endocrinology and Metabolism, 87</i>, 978-982. doi:10.1210/jc.87.3.978

Vilsboll, T., Knop, F. K., Kramp, T., Johansen, A., Madsbad, S., Larsen, S., … Holst, J. J. (2003). The pathophysiology of diabetes involves a defective amplification of the late phase insulin response to glucose by glucose-dependent insulinotropic polypeptide-regardless of etiology and phenotype. <i>Journal of Clinical Endocrinology and Metabolism, 88</i>, 4897-4903.

Weiser, M. A., Cabanillas, M. E., Konopleva, M., Thomas, D. A., Pierce, S. A., Escalante, C. P., … O'Brien, S. M. (2004). Relation between the duration of remission and hyperglycemia during induction chemotherapy for acute lymphocytic leukemia with a hyper-fractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone/methotrexate-cytarabine regimen. <i>Cancer, 100</i>, 1179-1185. doi:10.1002/cncr.20071

Will, J. C., Galuska, D. A., Vinicor, F., & Calle, E. E. (1998). Colorectal cancer: Another complication of diabetes mellitus? <i>American Journal of Epidemiology, 147</i>, 816-825.

Xu, J., Kochanek, K. D., Murphy, B. S., & Tejada-Vera, B. (2010). Deaths: Final data for 2007. <i>National Vital Statistics Reports, 58</i>(19), 1-6.

Yoder, L. H. (2006). An overview of lung cancer symptoms, patho-physiology, and treatment. <i>Medsurg Nursing, 15</i>, 231-235.