Understanding the Prevalence of Prediabetes and Diabetes in Patients With Cancer in Clinical Practice: A Real-World Cohort Study.

BACKGROUND: This study aimed to understand the prevalence of prediabetes (preDM) and diabetes mellitus (DM) in patients with cancer overall and by tumor site, cancer treatment, and time point in the cancer continuum. METHODS: This cohort study was conducted at Huntsman Cancer Institute at the University of Utah. Patients with a first primary invasive cancer enrolled in the Total Cancer Care protocol between July 2016 and July 2018 were eligible. Prevalence of preDM and DM was based on ICD code, laboratory tests for hemoglobin A1c, fasting plasma glucose, nonfasting blood glucose, or insulin prescription. RESULTS: The final cohort comprised 3,512 patients with cancer, with a mean age of 57.8 years at cancer diagnosis. Of all patients, 49.1% (n=1,724) were female. At cancer diagnosis, the prevalence of preDM and DM was 6.0% (95% CI, 5.3%-6.8%) and 12.2% (95% CI, 11.2%-13.3%), respectively. One year after diagnosis the prevalence was 16.6% (95% CI, 15.4%-17.9%) and 25.0% (95% CI, 23.6%-26.4%), respectively. At the end of the observation period, the prevalence of preDM and DM was 21.2% (95% CI, 19.9%-22.6%) and 32.6% (95% CI, 31.1%-34.2%), respectively. Patients with myeloma (39.2%; 95% CI, 32.6%-46.2%) had the highest prevalence of preDM, and those with pancreatic cancer had the highest prevalence of DM (65.1%; 95% CI, 57.0%-72.3%). Patients who underwent chemotherapy, radiotherapy, or immunotherapy had a higher prevalence of preDM and DM compared with those who did not undergo these therapies. CONCLUSIONS: Every second patient with cancer experiences preDM or DM. It is essential to foster interprofessional collaboration and to develop evidence-based practice guidelines. A better understanding of the impact of cancer treatment on the development of preDM and DM remains critical.

Evaluation of removable partial denture frameworks fabricated using 3 different techniques.

STATEMENT OF PROBLEM: Rapid advancements in computer-aided design and computer-aided manufacturing (CAD-CAM) have opened new pathways in the fabrication of removable partial dentures (RPDs) through additive and subtractive processes. Questions remain whether the digital pathway is an acceptable one compared with conventional analog or combined analog and digital pathways. PURPOSE: The purpose of this clinical study was to determine the quality of RPD frameworks fabricated using 3 different fabrication methods: analog, combined analog-digital, and digital. MATERIAL AND METHODS: Three RPD frameworks were fabricated for each of the 9 participants using each of the 3 techniques. Of the 9 participants enrolled, 4 were of Kennedy class I, 3 were of Kennedy class II, and 2 were of Kennedy class III. The first technique was completely analog: a physical impression was made using polyvinyl siloxane, stone casts were made, a survey was performed, and a laboratory technician waxed and cast the RPD framework. The combined analog-digital workflow had the analog steps, but the stone cast was scanned with a laboratory scanner to generate a digital cast. The 3Shape CAD software was then used to design a digital RPD, which was fabricated from a cobalt-chroumum alloy by selective laser melting. The third technique was completely digital: an intraoral digital scanner was used to make a definitive scan, which was sent to the 3Shape software for digitally designing the RPD framework and subsequent selective laser melting for fabrication. For all frameworks in the same participant, the same design was used for consistency. The evaluation consisted of a yes/no survey with 7 framework-related parameters and was completed by 5 clinicians. For statistics, an overall P value was calculated using a chi-squared test to determine any difference among the groups (α=.05). RESULTS: Seven of the 9 participants received the framework fabricated using the digital pathway as their definitive prosthesis. The completely digital method was significantly better than the traditional method of analog fabrication (P<.001). Intraoral scanning was also significantly better than the combined method of fabrication (P<.001). The completely analog method was better than the combined method of framework fabrication (P=.008). CONCLUSIONS: Within the limitations of this clinical study, it was concluded that the combined analog-digital pathway of RPD fabrication was the least clinically acceptable one as determined by 5 calibrated clinicians using a yes/no questionnaire, whereas the completely digital method of fabrication was found to be the best.

Diabetes, Body Fatness, and Insulin Prescription Among Adolescents and Young Adults with Cancer.

Purpose: Rates of obesity and obesity-related health consequences, including type 2 diabetes (T2D) and cancer, continue to rise. While cancer patients are at an increased risk of developing T2D, the prevalence of T2D and insulin prescription among young patients with cancer remains unknown. Methods: Using the Total Cancer Care Study cohort at Huntsman Cancer Institute (Salt Lake City, UT), we identified individuals age 18-39 years at cancer diagnosis between 2009 and 2019. Multivariable logistic regression was used to investigate associations between body mass index (BMI) with insulin prescription within 1 year of cancer diagnosis. Results: In total, 344 adolescents and young adults (AYAs) were diagnosed with primary invasive cancer. Within this cohort, 19 patients (5.5%) were ever diagnosed with T2D, 48 AYAs ever received an insulin prescription (14.0%), and 197 were overweight or obese (BMI: 25+ kg/m2) at cancer diagnosis. Each kg/m2 unit increase in BMI was associated with 6% increased odds of first insulin prescription within 1 year of cancer diagnosis among AYAs, even after adjustment for age, sex, smoking history, marital status, glucocorticoid prescription, and cancer treatments (odds ratio = 1.06, 95% confidence interval 1.02-1.11; p = 0.005). Conclusion: One in every 18 AYAs with cancer ever had T2D, 1 in 7 AYA patients with cancer ever received an insulin prescription, and higher BMI was associated with increased risk of insulin prescription within a year of cancer diagnosis among AYAs. Understanding the incidence of T2D and insulin prescription/use is critical for short-term and long-term clinical management of AYAs with cancer.