The quality of diabetes care among cancer survivors: a retrospective cohort study

Background — As cancer survivorship continues to improve, management of comorbid diabetes has become an increasingly important determinant of health outcomes for cancer patients. This study aimed to compare indicators of diabetes quality of care between diabetes patients with and without a history of cancer.

Methods — We used the Electronic Medical Record Administrative data Linked Database (EMRALD), a database of Ontario primary care EMR charts linked to administrative data, to identify patients with diabetes and at least 1 year follow‐up. Persons with a history of cancer were matched 1:2 on age, sex, and diabetes duration to those without cancer. We compared recommended diabetes quality of care indicators between persons with and without cancer using a matched cohort analysis.

Results — Among 229,627 patients with diabetes, we identified 2,275 cancer patients and 4,550 matched controls; 86.5% had diabetes diagnosed after cancer. Compared to controls, cancer patients with diabetes were significantly less likely to receive ACE inhibitors or angiotensin receptor blockers (OR 0.75 [95% CI 0.64‐0.89]), receive statin therapy if age 50‐80 years (OR 0.79 [95% CI 0.68‐0.92]), and achieve an LDL cholesterol level <2.0mmol/L (OR 0.82 [95% CI 0.74‐0.91]). There were no differences in recommended clinical testing or achieving A1C and blood pressure targets between groups.

Conclusion — Cancer survivors with diabetes are less likely to receive recommended cardiovascular risk‐reducing therapies compared to diabetes patients without cancer of similar age, sex, and diabetes duration. Further studies are warranted to determine if these associations are linked to worse survival, cardiovascular outcomes and quality of life.