Results of general internal medicine consultations for diabetes mellitus in 283 cancer patients

BACKGROUND: Diabetes is a major reason for patient referral to the General Internal Medicine (GIM) Department at M.D. Anderson Cancer Center. Previous studies of various factors that affect diabetes care have not focused on cancer patients. The objective of this study was to examine the level of diabetic care received by cancer patients. METHODS: We conducted a retrospective chart review of 283 consecutive GIM patients with diabetes in the years 2000 to 2001. For each patient, data were collected about the cancer, diabetes-related history, and the general internist's recommendations for further diabetes care. Patients were stratified by whether their cancer was controlled (stable or in remission) or uncontrolled (being actively treated by an oncologist or said to be progressive). χ tests and t tests were used to compare means for controlled cancer and uncontrolled cancer patient groups, with a value of P < 0.05 being considered significant. RESULTS: Patients with controlled cancer were more likely to have a lipid profile ordered (P < 0.001) or to be referred for diabetes-specific ophthalmology evaluation (P = 0.02). On logistic regression analysis, increasing patient age was associated with less frequent HgbA1c testing (P = 0.01), and both advanced age and uncontrolled cancer were associated with less lipid testing and ophthalmology referral. CONCLUSIONS: Patients with uncontrolled advanced cancer were not as aggressively treated for diabetes, especially if they were elderly. Further work should evaluate whether the observed level of diabetes care was appropriate and could affect patient outcome.