Intergenerational Technology Transfer: Enhancing African American Older Adults' Self-Efficacy for Diabetes Self-Management.

BACKGROUND: African American older adults are twice as likely to have diabetes than White older adults. Little is understood of African American older adults' self-efficacy in using technology to support recommended chronic disease self-management. OBJECTIVES: Our objective was to describe the feasibility of using a community-based health education session that used intergenerational technology transfer to promote use of technology to support self-management. The team designed a health and technology education session then measured its impact on African American older adults' self-efficacy for using technology to support self-management. METHODS: The community-based participatory research approach informed the study design which duplicated the sessions at the two study sites, in Detroit and Flint. We conducted a health education seminar in which older adults with diabetes shared insights on living with diabetes with younger adults they selected from their personal networks. The younger adults showed older adults how to access health information on smartphones. RESULTS: The sample included African American older adults (aged ≥50 years; n = 39) and younger adults (aged 18-49 years; n = 26). All participants showed improvements in self-efficacy for following recommendations for diet (i.e., preparing healthy meals [p = 0.0179]) and healthy diet behavior [p = 0.0044]) and physical activity (i.e., decrease in effort to exercise [p = 0.0185]), and for six of seven items, which measured confidence in using technology for self-management (e.g., using technology for health [p = 0.0002]). CONCLUSIONS: Findings provide foundational observations to inform evidence-based healthy aging interventions that use technology. Future research should explore the efficacy of community-based health education sessions with intergenerational technology transfer designed to support self-management.

Recruitment and retention of a challenging population: Lessons learned and design implications.

PURPOSE: The purpose of this article is share the lessons learned from recruiting and retaining adults with type 2 diabetes and solid tumor cancer into a longitudinal study exploring the relationship among chemotherapy, glycemic control, and symptoms. DESIGN/METHODS: Twelve-week longitudinal study, recruited thirty-four adults 21years or older with pre-existing type 2 diabetes and a solid tumor cancer, from three community based cancer centers who were eligible to receive outpatient chemotherapy. METHODS: Fisher's Exact Test (categorical variables) and Logistic Regression (continuous variables) were used to evaluate factors associated with participant withdrawal. A dichotomous attrition variable was created to identify those who dropped out of the study before the final week and those who completed. RESULTS: Thirteen of the 34 participants completed the study. Symptom severity, baseline HbA1c and metastases were all identified as being factors that potentially influenced attrition. Recruitment was improved once recruiters were hired at each of the cancer centers and adjustments made to the inclusion criteria. CONCLUSIONS/IMPLICATIONS FOR RESEARCH: Several design elements need to be considered to address attrition in future including the use of recruiters, inclusion and exclusion criteria, consent timing, data collection schedules, participant characteristics, participant burden, and support person identification.

Importance of Glycemic Control in Cancer Patients with Diabetes: Treatment through End of Life.

Cancer patients with diabetes are at increased risk for developing infections, being hospitalized, and requiring chemotherapy reductions or stoppages. While it has been hypothesized that glycemic control increases the risk for these adverse events, few studies have explored this hypothesis. The purpose of this paper is to discuss the importance of glycemic control in patients with diabetes and cancer during treatment through end of life. Glycemic control was found to play a role; the overall level of health-related quality of life experienced by patients with cancer and diabetes, level of symptom severity experienced and can impact the overall survival of the individual. Evidence-based policies and practice guidelines also need to be developed to help clinicians manage these patients during all phases of care. Using diabetes educators and advance practice, nurses to provide management and care coordination services need to be considered. Survivorship care plans should address both cancer and diabetes management. Finally, glycemic control should continue through end of life, with the main goal of avoiding hypoglycemic events.

Chemotherapy and Glycemic Control in Patients with Type 2 Diabetes and Cancer: A Comparative Case Analysis.

OBJECTIVE: Individuals with diabetes who develop cancer have a worse 5-year overall survival rate and are more likely to develop an infection and/or be hospitalized when compared to those without diabetes. Patients with diabetes and cancer receiving chemotherapy have an increased risk for developing glycemic issues. The relationship between chemotherapy and glycemic control is not completely understood. The aim of this study was to explore the relationship between glycemic control, symptoms, physical and mental function, development of adverse events, and chemotherapy reductions or stoppages in adults with Type 2 diabetes (T2D) and cancer. METHODS: A prospective 12-week longitudinal cohort study recruited 24 adults with T2D, solid tumor cancer, or lymphoma receiving outpatient intravenous chemotherapy. Eighteen individuals completed baseline data and were included in the analysis. A comparative case analysis was performed to analyze the results. RESULTS: Potential predictors of occurrence of an adverse event include sex (relative risk [RR] = 1.5), treatment with insulin (RR = 2.17), years with diabetes (RR = 3.85), and baseline glycated hemoglobin (HbA1c) (odds ratio [OR] = 1.67). Baseline body mass index (BMI) (OR = 1.16) and HbA1c (OR = 1.61) were potentially predictive of a chemotherapy stoppage. CONCLUSIONS: Level of glycemic control at the time an individual begins treatment for cancer appears to contribute to the occurrence of an adverse event, developing an infection and/or being hospitalized during treatment, and the increased risk of having a chemotherapy reduction or stoppage. Clinicians working with patients receiving chemotherapy for a solid tumor cancer who have pre-existing diabetes, need to be aware of how the patients glycemic level at the start of treatment may impact successful treatment completion.

Improving Coordination of Care Among Healthcare Professionals and Patients With Diabetes and Cancer.

BACKGROUND: Patients with diabetes and cancer have higher mortality and morbidity rates, and are more likely to be hospitalized during treatment. In addition, they often prioritize cancer treatment over self-management of diabetes. OBJECTIVES: This research aims to identify the issues regarding the management of diabetes in patients with cancer by examining the perspectives of oncology providers, nurses, and patients. METHODS: This study used six focus groups of oncology providers, nurses, and patients with preexisting diabetes who received chemotherapy for a solid tumor or lymphoma. Participants were recruited from two outpatient cancer centers in Michigan. All focus group discussions were audio recorded and transcribed, and thematic analysis was conducted to identify common themes. FINDINGS: Three overarching themes were identified by patients, nurses, and oncologists.

Controlling Malglycemia in Patients Undergoing Treatment for Cancer.

Patients with or without preexisting diabetes undergoing treatment for cancer may be at risk for malglycemic events. Malglycemia, particularly hyperglycemia and diabetes in patients with cancer, may lead to adverse outcomes. Prevention, prompt recognition, and early intervention to regulate malglycemia can optimize the effects of cancer treatment, minimize the harmful consequences, and improve quality of life for patients with cancer. The development of evidence-based standards of care and protocols are needed to guide clinical practice when caring for patients with cancer.

Examining patterns of multivariate, longitudinal symptom experiences among older adults with type 2 diabetes and cancer via cluster analysis.

PURPOSE: Diabetes and cancer are chronic conditions that produce symptoms, some unique to each condition and others common to both. Previous studies have reported on subgroups of patients who experience distinct combinations of symptoms in cross-sectional samples and the univariate longitudinal trajectories of individual symptoms. The literature currently lacks examples of research that take a multivariate longitudinal perspective to understanding patients' symptom experiences. The purpose of this study was to identify subgroups of patients who share distinct multivariate longitudinal profiles with respect to how symptom severity changes over time for a set of five symptoms (pain, fatigue, change in appetite, nausea, and numbness and tingling). METHODS: This exploratory study included 43 participants with pre-existing diabetes from eight community-based cancer centers who were receiving chemotherapy for a solid tumor. Using baseline and 8-week data, a model-based cluster analysis with Bayesian regularization was used to identify subgroups. RESULTS: Two groups were identified. Group 1 experienced mild symptoms that changed very little at 8 weeks; group 2 experienced mild to moderate symptom severity, with small increases in fatigue, nausea, and numbness and tingling. Effect size confidence intervals suggest that level of depression, length of time with diabetes, and severity of diabetes at baseline may differ between groups. CONCLUSIONS: More research in this area is needed to further test this model, address limitations associated with analyzing a small sample, and explore factors that may be associated with changes in the overall symptom experience for patients with diabetes and cancer.

Hyperglycemic-inducing neoadjuvant agents used in treatment of solid tumors: a review of the literature.

PURPOSE/OBJECTIVES: To review the literature regarding the development of hyperglycemia associated with neoadjuvant agents used in the treatment of solid tumor cancers. DATA SOURCES: Research articles were obtained from PubMed, CINAHL®, and Cochrane Reviews. The following search terms were used alone and in combination: diabetes, glycemic control, chemotherapy, androgen deprivation therapy, interferon-alpha, immunosuppressants, cancer, neoplasms, and hyperglycemia. DATA SYNTHESIS: Twenty-two studies were identified reporting the development of hyperglycemic events in patients who received a variety of chemotherapeutic agents. CONCLUSIONS: Findings suggest patients are at risk for the development of hyperglycemia from certain chemotherapeutic agents. Docetaxel, everolimus, and temsirolimus alone or in combination with other agents can promote hyperglycemia. Androgen-deprivation therapy commonly used in prostate cancer, increases the risk for the development of hyperglycemia and diabetes. IMPLICATIONS FOR NURSING: Oncology nurses play an important role in the identification and treatment of hyperglycemia in patients receiving chemotherapy. Future research is needed that focuses on the association between glycemic control and adverse outcomes in patients with a solid tumor cancer who are at risk for treatment-induced hyperglycemia.

Predictors of diabetes self-management in older adults receiving chemotherapy.

BACKGROUND: Cancer patients with diabetes have higher mortality rates and are more likely to develop infections, and be hospitalized during treatment. Hyperglycemia has been hypothesized as one of the factors associated with this increased risk. Diabetes self-management is one of the essential elements used by patients to maintain glucose levels. OBJECTIVE: This exploratory study seeks to develop an understanding of the impact cancer treatment can have on overall diabetes self-management and how individual, clinical, and behavioral characteristics may influence or predict the level of diabetes self-management in adults who are undergoing chemotherapy for a solid tumor cancer. METHODS: This study was conducted at 8 community-based cancer centers in Michigan and Ohio and used a written, self-administered survey at baseline and a phone survey 8 weeks later. RESULTS: Diabetes self-management significantly decreased (P < .001), and the level of symptom severity significantly increased (P < .001) after patients were on chemotherapy for a minimum of 8 weeks. The level of symptom severity and diabetes self-efficacy were significantly predictive of the performance of diabetes self-management activities. CONCLUSIONS: Chemotherapy and associated symptoms can have a negative impact on the performance of diabetes self-management activities in adults with both diabetes and cancer, increasing the risk for hyperglycemia and development of complications. IMPLICATIONS FOR PRACTICE: Oncology nurses need to be aware of the impact cancer treatment can have on the performance of diabetes self-management activities in adults. Future research needs to test interventions that may assist patients with diabetes and cancer in managing both diseases.

Hypoglycemia in patients with diabetes who are fasting for laboratory blood tests: the Cape Girardeau Hypoglycemia En Route Prevention Program.

OBJECTIVE: Patients with diabetes are routinely asked to fast for laboratory tests. If not properly prepared, they may be at risk for hypoglycemia, which may result in traffic accidents while driving en route to and from laboratory facilities. We undertook this study to evaluate the magnitude of this overlooked problem, and to evaluate the effectiveness of a prevention program implemented in our clinic. METHODS: A retrospective study consisting of chart reviews and telephone interviews of consecutive hypoglycemic events (blood glucose level < 70 mg/dL). The study cohorts, A and B, were extracted from our central laboratory database. Cohort A (from January 2008-September 2009) consisted of patients prior to--and cohort B (from October 2009-June 2011) subsequent to--the implementation of a prevention program involving blood glucose monitoring and adjustment of antidiabetic medications. Duration of each cohort was 21 months. For the purpose of this article, we use the acronym FEEHD (fasting-evoked en-route hypoglycemia in diabetes) to describe this overlooked form of hypoglycemia. RESULTS: Of a total of 1801 blood glucose test results retrieved, cohort A included a total of 55 hypoglycemic events in 51 patients (4 patients with 2 events each). Cohort B included a total of 23 hypoglycemic events in 22 patients (with 1 patient sustaining 2 events) out of a total of 2561 blood glucose test results retrieved. In cohort A, of 35 patients on antidiabetic medications who recalled fasting or probably fasting, there were 39 hypoglycemic events (2.2% frequency), compared with 18 events (0.7% frequency) in 17 patients in cohort B. This indicates a 68% risk reduction. The frequency of critical hypoglycemia (< 50 mg/dL) was more significantly reduced, from 11 events (0.6%) to 2 events (0.07%), indicating a risk reduction of 88%. CONCLUSION: This study showed a 68% risk reduction of FEEHD with implementation of the prevention program, and an 88% reduction of severe FEEHD (blood glucose level < 50 mg/dL). Reporting on the first prevention program of its kind, this is the first study to evaluate an overlooked safety problem in diabetes management. Clinicians should consider if fasting laboratory tests are in fact necessary, and when ordered, clinicians should properly instruct their patients on adequate blood glucose monitoring and adjustment of antidiabetic medications. We present the guidelines that proved effective in our program to help patients with diabetes and their clinicians avert this potentially harmful complication.

Diabetes and cancer: impact on health-related quality of life.

PURPOSE/OBJECTIVES: To explore whether three factors (physical function, mental health, and social function) of health-related quality of life (HRQOL) are impacted differently in patients with cancer and diabetes when compared to those with cancer who do not have diabetes at the beginning of chemotherapy. DESIGN: Secondary analysis using baseline data from two randomized, controlled trials. SETTING: Two comprehensive cancer centers, one community cancer oncology program, and six hospital-affiliated community oncology centers. SAMPLE: 661 patients aged 21 years or older with a solid tumor cancer or lymphoma undergoing cancer treatment. METHODS: Baseline data from both randomized, controlled trials were used. The SF-36® was used to measure physical function, mental health, and social function. Analysis included descriptive statistics and a general linear model. MAIN RESEARCH VARIABLES: Presence or absence of diabetes and physical function, social function, and mental health. FINDINGS: Patients with cancer and diabetes had significantly lower levels of physical function (p < 0.001) when compared to those who had cancer without diabetes. The interaction of diabetes and age was found to be significantly predictive of mental health (p < 0.05). CONCLUSIONS: The presence of diabetes negatively impacts physical function and mental health in patients undergoing chemotherapy. IMPLICATIONS FOR NURSING: Nurses should be aware of diabetes' effect on HRQOL in patients with cancer. In addition, nurses may need to intervene earlier for patients with diabetes and cancer to maintain or improve their quality of life.

Perceived impact of cancer treatment on diabetes self-management.

PURPOSE: The purpose of this study was to identify the impact that cancer and its treatment had on diabetes self-management and to identify common issues that individuals with diabetes encounter while undergoing chemotherapy. METHODS: This exploratory study utilized a baseline self-administered written survey and an 8-week telephone follow-up survey that included 2 open-ended questions. Forty-three adults aged 50 or older with diabetes and a solid tumor cancer receiving chemotherapy were recruited from 8 community outpatient cancer centers in Michigan and Ohio. Descriptives, t tests, and correlations were utilized to analyze the data. Content analysis was used to analyze the data from the open-ended questions. RESULTS: After a minimum of 8 weeks of chemotherapy, patients performed significantly fewer diabetes self-management behaviors. The majority of individuals experienced a moderate to high impact on their ability to perform diabetes self-management activities while receiving chemotherapy. Exercise, ability to eat and drink, and monitoring blood sugars were most affected. Three themes identifying patient issues were noted: self-management issues, health issues, and prioritization. CONCLUSIONS: Cancer treatment and cancer-related symptoms can have a negative impact on diabetes self-management behaviors in adults with diabetes who are undergoing chemotherapy. Diabetes self-management education is targeted to improve health outcomes in patients with diabetes and cancer and addresses the "cause" not just the "source" of the problem needs to be developed. Further research needs to be done to address issues related to glycemic control and health-related outcomes in this population.