title: Effects of cancer comorbidity on disease management: making the case for diabetes education (a report from the SOAR program).
abstract: Individuals with type II diabetes have an increased risk of cancer diagnosis (relative risk [RR]=1.12-2.50) and mortality (RR=1.4) compared to normoglycemic individuals. Biologic mechanisms, including mitogenic effects of insulin, hyperglycemia, and increased oxidative stress, as well as behavioral factors (eg, difficulty managing the comorbidity) may explain the elevated risk. To investigate the effects of the comorbidity on disease management, the authors compared diabetes education utilization in individuals with diabetes-cancer co-morbidity to utilization by individuals with diabetes in the absence of cancer. The effect of diabetes education on outcomes was further assessed in the subset of individuals with diabetes-cancer comorbidity. Administrative claims data were used for this analysis. The study population included individuals >60 years of age and members of both commercial and Medicare Advantage health plans from a private national database of payer data, but excluded Medicare fee for service and Medicaid patients. Most of these individuals were eligible to receive reimbursement for diabetes education. Diabetes education utilization was identified using procedure codes. Outcomes were assessed for a 3-year time period. There was little difference in diabetes education utilization between individuals with diabetes in the absence of cancer (3.8% utilization) and those with diabetes-cancer comorbidity (3.5% utilization). Individuals who receive diabetes education are more likely to have multiple HbA1c tests per year, fewer emergency department visits, fewer hospital admissions, and lower care-associated costs (except for outpatient and pharmacy averages). When diabetes coexists with cancer, management of diabetes often lags, making diabetes education an imperative.
authors.affiliation: Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
authors.forename: Lauren
authors.initials: L
authors.lastname: Irizarry
authors.forename: Qijuan E
authors.initials: QE
authors.lastname: Li
authors.forename: Ian
authors.initials: I
authors.lastname: Duncan
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Thurston
authors.forename: Karen A
authors.initials: KA
authors.lastname: Fitzner
authors.forename: Beatrice J
authors.initials: BJ
authors.lastname: Edwards
authors.forename: Judith M
authors.initials: JM
authors.lastname: McKoy-Bent
authors.forename: Katrina M
authors.initials: KM
authors.lastname: Tulas
authors.forename: June M
authors.initials: JM
authors.lastname: McKoy
mesh_terms: D000368:Aged; D015897:Comorbidity / Q000639:trends; D003920:Diabetes Mellitus / Q000453:epidemiology* / Q000628:therapy; D019468:Disease Management; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology* / Q000628:therapy; D010353:Patient Education as Topic / Q000458:organization & administration*; D016730:Program Development / Q000379:methods*; D014481:United States / Q000453:epidemiology