Comparison of diabetes management status between cancer survivors and the general population: results from a Korean population-based survey

Abstract

Purpose: This study aimed to determine and compare the prevalences of diabetes awareness, treatment, and adequate glycemic control among cancer survivors in a Korean population and two non-cancer control groups, comprising individuals without a history of cancer but with other chronic diseases (non-cancer, chronic disease controls) and individuals without a history of cancer or any other chronic disease (non-cancer, non-chronic disease controls).

Methods: We analyzed data from 2,660 subjects with prevalent diabetes (aged ≥30 years), who had participated in the 2007-2011 Korea National Health and Nutrition Examination Survey. Awareness was defined as a subject having been diagnosed with diabetes by a clinician. Treatment was defined as a subject who was taking anti-diabetic medicine. Adequate glycemic control was defined as a hemoglobin A1c level of <7%. Multivariable logistic regression and predictive margins were used to evaluate whether awareness, treatment, or adequate glycemic control differed among cancer survivors and the two non-cancer control groups.

Results: Cancer survivors had greater awareness compared with the non-cancer, chronic disease and non-cancer, non-chronic disease control groups (85.1%, 80.4%, and 60.4%, respectively). Although the prevalences of treatment and adequate glycemic control were higher for survivors compared with the non-cancer, non-chronic disease controls, they were lower compared with the non-cancer, chronic disease controls. The prevalence of diabetes treatment was 67.5% for cancer survivors, 69.5% for non-cancer, chronic disease controls, and 46.7% for non-cancer, non-chronic disease controls; the prevalences of adequate glycemic control in these three groups were 31.7%, 34.6%, and 17.8%, respectively.

Conclusions: Cancer survivors were less likely than the non-cancer chronic disease subjects to receive diabetes management and to achieve adequate glycemic targets. Special attention and education are required to ensure that this population receives optimal diabetes care, and the systematic roles for primary care and specialist physicians need to be determined.

Figure 1. The process used to select the study population.

KNHANES, Korea National Health and Nutrition Examination Survey. *Subjects with fasting plasma glucose levels of ≥126 mg/dL, or with a previous clinical diagnosis of diabetes made by a physician, or taking insulin or oral anti-diabetic medication.

Figure 2. Prevalence of: (A) diabetes treatment; and (B) adequate glycemic control, among the cancer survivor and control groups with prevalent diabetes, according to diabetes duration.

Model 1 was adjusted for age and sex; Model 2 was additionally adjusted for education and BMI. We adjusted for multiple tests by applying the Bonferroni method. ^a p-value<0.05 when compared with cancer survivors. ^b p-value<0.05 when compared with non-cancer non-chronic disease controls. ^c p-value<0.15 when compared with cancer survivors. ^d p-value<0.15 when compared with non-cancer non-chronic disease controls.