Identifying ways to improve diabetes management during cancer treatments (INDICATE): protocol for a qualitative interview study with patients and clinicians

Abstract

IntroductionA large and growing number of patients with cancer have comorbid diabetes. Cancer and its treatment can adversely impact glycaemic management and control, and there is accumulating evidence that suboptimal glycaemic control during cancer treatment is a contributory driver of worse cancer-related outcomes in patients with comorbid diabetes. Little research has sought to understand, from the perspective of patients and clinicians, how and why different aspects of cancer care and diabetes care can complicate or facilitate each other, which is key to informing interventions to improve diabetes management during cancer treatments. This study aims to identify and elucidate barriers and enablers to effective diabetes management and control during cancer treatments, and potential intervention targets and strategies to address and harness these, respectively.Methods and analysisQualitative interviews will be conducted with people with diabetes and comorbid cancer (n=30–40) and a range of clinicians (n=30–40) involved in caring for this patient group (eg, oncologists, diabetologists, specialist nurses, general practitioners). Semistructured interviews will examine participants’ experiences of and perspectives on diabetes management and control during cancer treatments. Data will be analysed using framework analysis. Data collection and analysis will be informed by the Theoretical Domains Framework, and related Theory and Techniques Tool and Behaviour Change Wheel, to facilitate examination of a comprehensive range of barriers and enablers and support identification of pertinent and feasible intervention approaches. Study dates: January 2021–January 2023.Ethics and disseminationThe study has approval from National Health Service (NHS) West Midlands—Edgbaston Research Ethics Committee. Findings will be presented to lay, clinical, academic and NHS and charity service–provider audiences via dissemination of written summaries and presentations, and published in peer-reviewed journals. Findings will be used to inform development and implementation of clinical, health services and patient-management intervention strategies to optimise diabetes management and control during cancer treatments.

Pharmaceutical characterization and exploration of Arkeshwara rasa in MDA-MB-231 cells

“…The high expression of the MCM2, MCM4-7 and MCM10 in breast cancer patients are associated with high Relapse Free Survival (RFS) explained with data expression from Oncomine, GEPIA and cBioportal analysis [ 46 ]. The Abscisic acid (ABA) is known to create glucose tolerance and aids the uptake, simultaneously with insulin secretion and GLP-1 activity to accommodate the hepatocyte activity with the rapid glycolysis in TNBC cells [ 47 ]. The presence of ABA in citrus components [ 48 ] and also secretions from granulocytes [ 49 ], monocytes [ 50 ], macrophages, adipocytes [ 50 ], pancreatic β cells [ 51 ], etc might be preserving the glucose homeostasis.…”

The Value of Glycemic Control Prior to Cancer Diagnosis on All-Cause Mortality among Patients with Type 2 Diabetes in Dutch Primary Care

“…An evaluation of the quality of glycemic control between patients with colorectal cancer and no cancer in primary care revealed comparable probabilities of reaching the target level ( 20 ). Among patients with comorbid cancer and T2DM, it is suspected that glycemic control plays an important role on survival ( 21 ).…”