title: Undiagnosed diabetes in breast, colorectal, lung, and prostate cancer: incidence and risk factors.
abstract: Our study describes the incidence and risk factors for undiagnosed diabetes in elderly cancer patients. Using Surveillance, Epidemiology, and End Results-Medicare data, we followed patients with breast, colorectal, lung, or prostate cancer from 24 months before to 3 months after cancer diagnosis. Medicare claims were used to exclude patients with diabetes 24 to 4 months before cancer (look-back period), identify those with diabetes undiagnosed until cancer, and construct indicators of preventive services, physician contact, and comorbidity during the look-back period. Logistic regression analyses were performed to identify factors associated with undiagnosed diabetes. Overall, 2,678 patients had diabetes undiagnosed until cancer. Rates were the highest in patients with both advanced-stage cancer and low prior primary care/medical specialist contact (breast 8.2%, colorectal 5.9%, lung 4.4%). Nonwhite race/ethnicity, living in a census tract with a higher percent of the population in poverty and a lower percent college educated, lower prior preventive services use, and lack of primary care and/or medical specialist care prior to cancer all were associated with higher (P ≤ 0.05) adjusted odds of undiagnosed diabetes. Undiagnosed diabetes is relatively common in selected subgroups of cancer patients, including those already at high risk of poor outcomes due to advanced cancer stage.
authors.affiliation: Nuffield Department of Primary Care Health Sciences, University of Oxford, 23-38 Hythe Bridge Street, 2nd Floor, Oxford OX1 2ET, UK ; Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.
authors.forename: Robert I
authors.initials: RI
authors.lastname: Griffiths
authors.affiliation: Department of Epidemiology, Outcomes Insights, Inc., Westlake Village, CA 91362, USA.
authors.forename: Karla J
authors.initials: KJ
authors.lastname: Lindquist
authors.affiliation: Center for Observational Research, Amgen Inc., Thousand Oaks, CA 91320, USA.
authors.forename: Cynthia D
authors.initials: CD
authors.lastname: O'Malley
authors.affiliation: Department of Epidemiology, Outcomes Insights, Inc., Westlake Village, CA 91362, USA.
authors.forename: Michelle L
authors.initials: ML
authors.lastname: Gleeson
authors.affiliation: Department of Epidemiology, Outcomes Insights, Inc., Westlake Village, CA 91362, USA.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Duryea
authors.affiliation: Nuffield Department of Primary Care Health Sciences, University of Oxford, 23-38 Hythe Bridge Street, 2nd Floor, Oxford OX1 2ET, UK.
authors.forename: José M
authors.initials: JM
authors.lastname: Valderas
authors.affiliation: Department of Epidemiology, Outcomes Insights, Inc., Westlake Village, CA 91362, USA.
authors.forename: Mark D
authors.initials: MD
authors.lastname: Danese
references.citation: Health Serv Res. 2004 Oct;39(5):1403-27
references.pmid: 15333115
references.citation: Am J Epidemiol. 2004 Jun 15;159(12):1160-7
references.pmid: 15191933
references.citation: Med Care. 2002 Aug;40(8 Suppl):IV-3-18
references.pmid: 12187163
references.citation: Ann Oncol. 2012 Jul;23(7):1756-65
references.pmid: 22039090
references.citation: Lancet Oncol. 2005 Feb;6(2):103-11
references.pmid: 15683819
references.citation: J Chronic Dis. 1987;40(5):373-83
references.pmid: 3558716
references.citation: J Clin Epidemiol. 1994 Mar;47(3):249-60
references.pmid: 8138835
references.citation: J Clin Epidemiol. 2000 Dec;53(12):1258-67
references.pmid: 11146273
references.citation: JAMA. 2008 Dec 17;300(23):2754-64
references.pmid: 19088353
references.citation: J Clin Oncol. 2009 Jan 10;27(2):176-85
references.pmid: 19064975
references.citation: Lancet Oncol. 2008 Nov;9(11):1039-47
references.pmid: 18835745
references.citation: J Gen Intern Med. 2006 Apr;21(4):386-92
references.pmid: 16686819
references.citation: J Gen Intern Med. 2005 Jan;20(1):38-44
references.pmid: 15693926
references.citation: Am J Epidemiol. 2003 Jun 15;157(12):1092-100
references.pmid: 12796045
references.citation: Ann Epidemiol. 2007 Aug;17(8):584-90
references.pmid: 17531502
references.citation: Diabetes Care. 2003 Apr;26(4):1047-51
references.pmid: 12663571
references.citation: Diabetes Care. 2007 Jun;30(6):1466-72
references.pmid: 17351285
references.citation: Cancer. 2004 Mar 15;100(6):1179-85
references.pmid: 15022284
references.citation: J Clin Epidemiol. 1992 Jun;45(6):613-9
references.pmid: 1607900
references.citation: Breast Cancer Res Treat. 2008 May;109(2):389-95
references.pmid: 17659440
references.citation: Nat Clin Pract Oncol. 2005 Jan;2(1):48-53
references.pmid: 16264856
references.citation: Med Care. 2005 Feb;43(2):132-40
references.pmid: 15655426
references.citation: J Clin Oncol. 2003 Feb 1;21(3):433-40
references.pmid: 12560431
references.citation: Diabetes Care. 2010 Jul;33(7):1674-85
references.pmid: 20587728
references.citation: Int J Cancer. 2007 May 1;120(9):1986-92
references.pmid: 17230509
references.citation: Cancer Causes Control. 2009 May;20(4):417-35
references.pmid: 19002764
references.citation: Am J Med Qual. 1999 Nov-Dec;14(6):270-7
references.pmid: 10624032