This  blog explores the relationship between cancer and diabetes. We differentiate the risk of cancer for people with type 1 and type 2 diabetes. Lastly, we explore the importance of diabetes educators in promoting lifestyle change and being involved early detection and cancer prevention.

Together, we can help those living with diabetes take early action and get appropriate screenings!

Type 1 and Type 2 Diabetes
What’s the Link?

Cancer is the 2nd Leading Cause of Death in the United States.

Diabetes is the 7th leading cause of death.

What is the intersection between diabetes and cancer?

In 2010, Diabetes and Cancer, a Consensus Statement was the first official report that brought this connection to light. Since that initial publication, our understanding of this co-relationship continues to evolve. This article highlights these newer findings.

There are risk factors that are common to both diseases:

• Aging
• Obesity
• Diet
• Physical Inactivity
• Alcohol
• Smoking
• Ethnicity

In addition, there are some possible mechanisms for a direct link. People with diabetes and cancer share:

• Inflammation
• Hyperglycemia
• Hyperinsulinemia

In both conditions, cellular inflammation exists and some researchers have suggested that the abundance of glucose feeds hungry tumor cells.

Cancer and Diabetes Rates

Type 1 Diabetes and Cancer – Risk Compared to general population.

Increased Cancer Risk of:       

• Stomach                        
• Liver
• Kidney
• Pancreas
• Endometrium

Decreased Cancer Risk of:

• Breast
• Prostate

Type 2 Diabetes and Cancer – Risk Compared to general population.
Increased Cancer Risk of:

• Liver
• Pancreas
• Endometrium
• Breast
• Bladder
• Colon

Decreased Cancer Risk of:

• Prostate

Prevention and Screenings are Critical
Since the link between diabetes and cancer seems to be due in part to shared risk factors such as obesity, diet and inactivity, we can continue to promote the usual lifestyle adjustments:

• Promote healthy diet, high in fiber, fruits and vegetables and decrease meat intake
• Increased activity and weight loss improves outcomes of type 2 diabetes and some forms of cancer.
• Strongly encourage people with diabetes to undergo appropriate cancer screenings. This is especially true for people with type 2, who tend to receive less cancer screenings than those with type 1 diabetes.

Diabetes Medications and Cancer

Some diabetes medications should not be used in patients at risk of certain cancers.

• Pioglitazone (Actos) may increase bladder cancer risk.
• Dapagliflozin (Farxiga) should not be used in patients with bladder cancers.
• GLP-1 Receptor Agonists should not be used in patients at risk for medullary thyroid tumor.

Download Medication PocketCard for reference »

Metformin may have some cancer protective qualities.

Metformin is a plant based derivative. It originates from French Lilac, Galega Officinalis.

Results of a growing number of observational human studies suggest that treatment with metformin (relative to other glucose-lowering therapies) is associated with reduced risk of cancer or cancer mortality. 
There are trials underway to see if metformin is associated with slowing cellular aging and increasing telomere length. 

As diabetes educators, we can help increase awareness of the association between cancer and diabetes. We can inform and advocate to make sure patients get appropriate screenings with a focus on early detection.

Want to learn more?
Join us to explore the relationship between cancer and diabetes and to use a case study approach to determine best strategies to manage hyperglycemia during chemotherapy on steroids.

Diabetes and Cancer Course – Earn 1.5 CEs >>
This On Demand Presentation now available
Earn 1.5 CEs and learn more about this important topic.

An estimated 86 million Americans have prediabetes, and 90 percent of them don’t know they have it.

Prediabetes can lead to type 2 diabetes and its many serious complications. It’s crucial for people to know their risk because prediabetes can be reversed with healthy food choices, weight loss, exercise, other lifestyle changes and medication.

On March 28, Diabetes Education Services is joining the American Diabetes Association for a one-day wake-up call, #DiabetesAlert Day!

Share the one-minute Type 2 Diabetes Risk Test in your work place, communities and your social media sites.

Together, we can help those living with undetected prediabetes and diabetes take early action to keep healthy!

ADA Alert Day E-Toolkit  – Help your organization prepare for the Sound the Alert Day.

ADA Diabetes Risk Test Paper Version can identify those at risk and promote behavior change action for individuals and their communities.  In English and Spanish.

Risk Test for PreDiabetes >> A user friendly web page that evaluates risk and provides helpful info

“Are you at Risk?” Page by the American Diabetes Association  – includes the Risk Test, strategies to lower risk and information on predidabetes.

My Health Advisor by ADA
The path to good health just got a lot easier. Enter some basic health information and My Health Advisor will calculate risk for type 2 diabetes, heart disease and stroke. 

BMI Calculator – A fast and easy way to calculate a patients BMI

National Institutes of Health – Managing Diabetes – It’s Not Easy, But It’s Worth It

Exercise Resource Page – We created this resource page so that you would have helpful exercise resources available for you and your colleagues. There are handouts and links that you can share with patients too!

Apps for Diabetes – an array of apps that reviewers have found  helpful for people living with diabetes.

A study published earlier this month by Diabetologia tested a possible link between oral hygiene and new-onset diabetes.

In an attempt to determine if there is a relationship between periodontal (gum) disease and the rate of new-onset diabetes, Yoonkyung Chang, Ph.D., and researches at the Ewha Woman’s University College of Medicine in Seoul, South Korea, analyzed a series of data collected by the National Health Insurance System-Health Screening Cohort (NHIS-HEALS). This data which was collected from 2003 to 2006, across more than 188,000 subjects, found a positive link between oral care and new-onset diabetes.

Of the included subjects, 17.5% had periodontal disease. After a median follow-up of 10.0 years, diabetes developed in 31,545 (event rate: 16.1%, 95% CI 15.9%, 16.3%) subjects.

The correlation between periodontal disease and new-onset diabetes remained positively associated even after adjusting the data for demographics and lifestyle choices such as regular exercise, alcohol consumption, and vascular risk factors, among others.

The good news is that the study did find that regular tooth brushing (3x a day) had a negative association with new-onset diabetes.

To read more about this study, click here.

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We are so excited to share Eat Right’s National Nutrition Month® Campaign Toolkit with you!

Made by the Academy of Nutrition and Dietetics, this toolkit includes tip sheets, handouts, games, PSAs, and planning materials to incorporate into your practice. There is even a list of materials in Spanish!

Click here to see the full toolkit!

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For the Question of the week, QoW, test takers usually choose the correct answer 70-80% of the time. However, for one question of the week, about 40% of respondents chose the correct answer.

So, we thought this would be a perfect opportunity for another answer rationale. We’ll explore this question and the best answer in more detail and throw in some test-taking tips along the way. Before we start though, if you don’t want any spoilers and haven’t tried the question yet, you can answer below:

Question of the week:

What is a common educator or provider barrier to care for the LGBTQ population?

Answer Choices:

1. Being aware of personal biases.
2. Understanding those in a same-sex relationship may be concerned how an illness or its treatment will have on fertility.
3. Knowing that all people seeking care may wish to discuss relationship issues.
4. Assuming person is straight or belongs to the LGBTQ population.

As shown above, the most common choice was option 4, the second most common answer was option 1, then option 2, and finally option 3.

Option 1 is incorrect. Being aware of our personal bias is not a barrier. It helps us to explore and be cognizant of our personal beliefs.

Option 2 is incorrect. This answer considers that the same sex couple may be interested in pursuing having children. In addition, this response shows the educator or provider is aware this is a barrier.

Option 3 is incorrect. People in the LBGTQ community may want the opportunity to discuss relationship issues as it allows them to feel respected as a person, get your support and understanding as to how their social structure relates to their diabetes care.

Option 4 is the correct answer. Assuming a person is straight or belongs to the LGBTQ population is a common barrier to providing person-centered care. Learn more about effective communication in our January Newsletter with our guest contributor, Ms. Theresa Garnero.

We hope you appreciate this week’s rationale and keep studying hard! Thank you so much for taking the time to answer our Question of the Week and participate in this fun learning activity!

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Garnero, T. L. (2010) Providing Culturally Sensitive Care for LGBT with Diabetes. Diabetes Spectrum, 23(3): 178-182. https://doi.org/10.2337/diaspect.23.3.178

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Section 13 – Management of Diabetes in Pregnancy
These are the updated guidelines from the 2017 ADA Standards of Care, Section 13 page S115.

Insulin treatment of Choice – insulin was emphasized as the treatment of choice in pregnancy based on the concerns about the concentration of metformin on the fetal side of the placenta and glyburide levels in cord blood.

Glucose testing and goals – based on evidence, more emphasis will be placed on post-prandial targets and less on pre-prandial values.

To simplify, fasting and postprandial targets are now the same for pregnant women with pre-existing diabetes and gestational diabetes.

Pregnancy and Blood Pressure Goals – for pregnant patients with diabetes and chronic hypertension, the new blood pressure target is 120-160/80-105 mmHg. This target is to optimize maternal health without causing fetal harm. Antihypertensive drugs known to be effective and safe in pregnancy include methyldopa, labetalol, diltiazem, clonidine, and prazosin.

 

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Diabetes Educators often ask for guidelines to manage BG Levels while patients are on parenteral or tube feedings. Here is a handy little chart that I was published in the 2017 Standards of Care, in section 14, Diabetes Care in the Hospital (page s124).  I think if offers some sound, practical guidelines that we can share with our hospital colleagues.

 

 

 

 

 

 

 

 

 

 

 

 

 

From ADA Standards of Care 2017 – Page S12

The rate of progression is dependent on the age at first detection of antibody, number of antibodies, antibody specificity, and antibody titer.
Glucose and A1C levels rise well before the clinical onset of diabetes, making diagnosis feasible well before the onset of DKA.
Three distinct stages of type 1 diabetes can be identified (Table 2.1) and serve as a framework for future research and regulatory decision making (4,5).