Diabetes Management and Self-Care Education for Hospitalized Patients With Cancer

Abstract

Managing diabetes can be a daunting task for patients with cancer. Empowerment-based diabetes education and motivational interviewing are complementary approaches. Oncology nurses may feel unprepared to teach patients and their families about self-care for diabetes, but they provide individualized information on symptom management of cancer throughout hospitalization and at discharge. The essential self-care issues include food, exercise, medication, blood glucose monitoring, prevention, recognition and treatment of hypoglycemia and hyperglycemia, and when and how to get additional medical and educational support. This patient-centered model of diabetes education differs from the older "compliance" model that covers many universal rules for all patients, which are predetermined by the nurse. Informing nurses about their role in care of patients with cancer and diabetes is critical.The incidence of diabetes in the United States continues to rise, with 23.6 million Americans (8% of the population) affected (Centers for Disease Control and Prevention [CDC], 2007). Healthy People 2010 (2000a) has two major goals: increase quality and years of healthy life and eliminate health disparities. The priority focus regarding diabetes is reducing the economic burden and improving quality of life for all people who have or are at risk for diabetes (Healthy People 2010, 2000b. The treatment of diabetes and its accompanying complications are costly, $100 billion annually in the United States and continuing to rise (Garber et al., 2004). Diabetes affects 8%-18% of patients with cancer and can negatively influence the outcomes of treatment (Psarakis, 2006;Singer, 2007). The American Cancer Society ([ACS], 2008) estimates that 1.4 million new cases of cancer will be diagnosed in 2008, and 112,000-252,000 also will have or develop diabetes, making it a significant comorbid condition. Peripheral neuropathies in people with diabetes coupled with chemotherapeutic agents can result in increased toxicities, morbidities, and the potential for treatment discontinuation (Visovsky, Meyer, Roller, & Poppas, 2008).Many patients with cancer have diabetes, usually type 2 or pre-diabetes, at the time of diagnosis and require dual management of the two conditions (Psarakis, 2006). In addition, several chemotherapeutic regimens such as CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) and combinations of steroids can lead to hyperglycemia (Oyer, Shah, & Bettenhausen, 2006 ) recommends an HgA1c less than 7%, which reflects an average blood glucose of less than 170 mg/dl. The closer a patient is to that goal, the less he or she is at risk of developing microvascular complications (ADA). The target goal of less than 170 mg/dl may have to be assessed based on clinical presentation of the patient and existing health problems.Oncology nurses care for patients with chronic diseases, cancer, and diabetes, and educating and supporting patients with diabetes are critical. Most patients with diabetes self-manage the condition through ...

Long-term diabetes risk among endometrial cancer survivors in a population-based cohort study

“…Paclitaxel/carboplatin, one of the most common chemotherapy combinations for endometrial cancer [27] may induce hyperglycemia [28]. In addition, medications to manage side effects resulting from chemotherapy may also induce hyperglycemia [29]. However, our results suggest that there is no association between cancer treatment and the risk of type II diabetes among endometrial cancer survivors.…”

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

“…Blood glucose control often becomes more difficult during times of acute illness, especially cancer, and patients will require additional help in managing both conditions. For example, medications commonly given with cancer treatment, such as glucocorticoids, may increase episodes of hyperglycemia (Leak, Davis, Houchin, & Mabrey, 2009), and chemotherapy may also affect blood glucose levels (Hershey, Bryant, et al, 2014). The challenges this patient population faces while undergoing chemotherapy can influence overall health outcomes but are not clearly understood.…”

Alterações cognitivas, funcionalidade e qualidade de vida de pacientes portadores de Diabetes Mellitus em uma unidade básica de saúde

“…O conjunto de sintomas caracterizado por incapacidade no planejamento de metas e objetivos, dificuldade em auto regulação (40,41) , dificuldade de avaliar com acurácia o sucesso ou fracasso de seu desempenho e, especialmente incapacidade de usar as informações para mudar seus comportamentos futuros, é denominado como síndrome de disfunção executiva (Dysexecutive Syndrome) (42)(43)(44)(45) . O prejuízo nas funções executivas (FE), impactam na capacidade adaptativa do indivíduo e no desempenho de tarefas da vida diária ou em relação ao convívio social apropriado.…”

“…O prejuízo nas funções executivas (FE), impactam na capacidade adaptativa do indivíduo e no desempenho de tarefas da vida diária ou em relação ao convívio social apropriado. Leak (1995) (41) descreveu as FE como processos cognitivos especializados com uma série de habilidades cognitivas e princípios de organização. As funções executivas referem-se a funções cognitivas de nível superior que são principalmente mediadas pelos lobos frontais.…”

“…Finalmente, foi observado que pacientes portadores de DM apresentam, além de declínio cognitivo (47) em relação a pessoas sem DM, maior chance de desenvolverem incapacidade funcional (48)(49)(50) . (40,41) .…”