Preventable Diabetic Complications After a Cancer Diagnosis in Patients With Diabetes: A Population-Based Cohort Study

Abstract

Background: A cancer diagnosis may disrupt diabetes management, increasing the risk of preventable complications. The objective was to determine whether a cancer diagnosis in patients with diabetes is associated with an increased risk of diabetic complications.

Methods: This retrospective cohort study using health care data from Ontario, Canada, included persons age 50 years or older diagnosed with diabetes from 2007 to 2011 and followed until 2014. We examined the effects of cancer as a time-varying covariate: breast cancer (in women), prostate cancer (in men), colorectal cancer, and other cancers (in men and women). Each cancer exposure was categorized as stage I-III, IV, or unknown, and by time since cancer diagnosis (0-1 year, >1-3 years, and >3 years). The primary outcome was hospital visits for diabetic emergencies. Secondary outcomes were hospital visits for skin and soft tissue infections and cardiovascular events.

Results: Of 817 060 patients with diabetes (mean age = 64.9 +/- 10.7 years), there were 9759 (1.2%) colorectal and 45 705 (5.6%) other cancers, 6714 (1.7%) breast cancers among 384 257 women and 10 331 (2.4%) prostate cancers among 432 803 men. For all cancers except stage I-III prostate cancer, rates of diabetic complications were significantly higher zero years to one year after diagnosis compared with no cancer (adjusted relative rates ranging from 1.26, 95% confidence interval [CI] = 1.08 to 1.49, to 4.07, 95% CI = 3.80 to 4.36); these differences were attenuated in the subsequent periods after cancer diagnosis.

Conclusions: Patients with diabetes are at increased risk for preventable complications after a cancer diagnosis. Better diabetes care is needed during this vulnerable period.

Figure 1.

Description of the cohort selection of persons with diabetes, with and without a cancer diagnosis. LTC = Long-term care facility; OHIP = Ontario Health Insurance Plan.

Figure 2.

Rates of the outcomes of interest (diabetic emergencies, skin and soft tissue infections, and cardiovascular events) among patients without cancer and among patients who developed (A) breast cancer; (B) prostate cancer; (C) colorectal cancer; and (D) other cancer, expressed in rate per 100 person-years. For the graphs showing the rates of the outcomes of interest among patients with colorectal cancer (C) and other cancer (D), the cohort of patients included all men and women, whereas for breast cancer (A), the cohort of patients included only women, and for prostate cancer (B), the cohort of patients included only men.

Figure 3.

Adjusted relative rates of diabetic emergencies, skin and soft tissue infections, and cardiovascular events in patients diagnosed within the first year after cancer diagnosis compared with patients without cancer: (A) breast cancer (women); (B) prostate cancer (men); (C) colorectal cancer (men and women); and (D) other cancers (men and women). Data points represent relative rates calculated for each cancer stage category, with bars representing 95% confidence intervals. CI = confidence interval.

Figure 4.

Adjusted relative rates of diabetic emergencies, skin and soft tissue infections, and cardiovascular events in patients diagnosed within the second and third years after cancer diagnosis compared with patients without cancer: (A) breast cancer (women); (B) prostate cancer (men); (C) colorectal cancer (men and women); and (D) other cancers (men and women). Data points represent relative rates calculated for each cancer stage category, with bars representing 95% confidence intervals. CI = confidence interval.