Gennaro Clemente1, Marisa Giorgini2, Marcello Mancini3, Marco Gallo4. 1. IRPPS-Institute for Research on Population and Social Policies of the Italian National Research Council, Fisciano, Salerno, Italy. Electronic address: gennaro.clemente@cnr.it. 2. Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy. 3. IBB-Institute of Biostructure and Bioimaging, of the Italian National Research Council, Naples, Italy. 4. Oncological Endocrinology Unit, Department of Medical Sciences, University of Turin, AOU Città della Salute e della Scienza di Torino, Turin, Italy.
Abstract
AIMS: Diabetes and cancer frequently coexist in the same subject, often having relevant effects on the management and prognosis of the oncologic patient. However, existing guidelines do not deal with many clinical issues in this setting appropriately. In evaluating the opinions of Diabetologists and Oncologists dealing with diabetes care in people with cancer, the Italian Association of Diabetologists (AMD) promoted a dedicated exploratory survey. METHODS: The survey was carried out through the web or handily delivered printed copies between October 2014 and April 2015, in Italy. It was composed of 27 questions intended to gather information on the characteristics of participants and to examine their clinical habits in this context, and participation was totally free and anonymous. RESULTS: A total of 252 physicians participated in the survey. Diabetologists accounted for 51.1% of respondents. According to survey results, in spite of the presence of diabetes (or diabetic complications) worsening the outcome of cancer treatments, the counseling or intervention of a Diabetologist was only required for less than two-thirds of hospitalized patients. For subjects with a life expectancy of months, 80% of specialists considered a glycemic target of 120-250 mg/dL optimal whereas Oncologists were more likely to consider a range of 180-360 mg/dL for patients with a shorter life expectancy. Furthermore, 1 participant out of 3 indicated 1-4 measurements/day as the most appropriate frequency for blood glucose monitoring including in the palliative setting. Insulin was the therapy of choice for the majority of respondents albeit with different routes of administration. CONCLUSIONS: This survey provides interesting preliminary data that could help facilitate and optimize the management of patients with cancer and diabetes, promoting the delivery of an organic answer to fragmented assistance, to potentially inappropriate behaviors, and to a tailored therapy in a context of particular clinical fragility.
AIMS: Diabetes and cancer frequently coexist in the same subject, often having relevant effects on the management and prognosis of the oncologic patient. However, existing guidelines do not deal with many clinical issues in this setting appropriately. In evaluating the opinions of Diabetologists and Oncologists dealing with diabetes care in people with cancer, the Italian Association of Diabetologists (AMD) promoted a dedicated exploratory survey. METHODS: The survey was carried out through the web or handily delivered printed copies between October 2014 and April 2015, in Italy. It was composed of 27 questions intended to gather information on the characteristics of participants and to examine their clinical habits in this context, and participation was totally free and anonymous. RESULTS: A total of 252 physicians participated in the survey. Diabetologists accounted for 51.1% of respondents. According to survey results, in spite of the presence of diabetes (or diabetic complications) worsening the outcome of cancer treatments, the counseling or intervention of a Diabetologist was only required for less than two-thirds of hospitalized patients. For subjects with a life expectancy of months, 80% of specialists considered a glycemic target of 120-250 mg/dL optimal whereas Oncologists were more likely to consider a range of 180-360 mg/dL for patients with a shorter life expectancy. Furthermore, 1 participant out of 3 indicated 1-4 measurements/day as the most appropriate frequency for blood glucose monitoring including in the palliative setting. Insulin was the therapy of choice for the majority of respondents albeit with different routes of administration. CONCLUSIONS: This survey provides interesting preliminary data that could help facilitate and optimize the management of patients with cancer and diabetes, promoting the delivery of an organic answer to fragmented assistance, to potentially inappropriate behaviors, and to a tailored therapy in a context of particular clinical fragility.
Authors: Rita Bettencourt-Silva; Beatriz Aguiar; Vânia Sá-Araújo; Rosa Barreira; Vânia Guedes; Maria João Marques Ribeiro; Davide Carvalho; Linda Östlundh; Marília Silva Paulo Journal: BMJ Open Date: 2019-06-14 Impact factor: 2.692