About this Journal Submit a Manuscript Table of Contents
ISRN Oncology
Volume 2014 (2014), Article ID 607850, 10 pages
Clinical Study

Undiagnosed Diabetes in Breast, Colorectal, Lung, and Prostate Cancer: Incidence and Risk Factors

1Nuffield Department of Primary Care Health Sciences, University of Oxford, 23-38 Hythe Bridge Street, 2nd Floor, Oxford OX1 2ET, UK
2Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
3Department of Epidemiology, Outcomes Insights, Inc., Westlake Village, CA 91362, USA
4Center for Observational Research, Amgen Inc., Thousand Oaks, CA 91320, USA

Received 5 November 2013; Accepted 20 January 2014; Published 4 March 2014

Academic Editors: Z. S. Guo and Z. Suo

Copyright © 2014 Robert I. Griffiths et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Our study describes the incidence and risk factors for undiagnosed diabetes in elderly cancer patients. Using Surveillance, Epidemiology, and End Results-Medicare data, we followed patients with breast, colorectal, lung, or prostate cancer from 24 months before to 3 months after cancer diagnosis. Medicare claims were used to exclude patients with diabetes 24 to 4 months before cancer (look-back period), identify those with diabetes undiagnosed until cancer, and construct indicators of preventive services, physician contact, and comorbidity during the look-back period. Logistic regression analyses were performed to identify factors associated with undiagnosed diabetes. Overall, 2,678 patients had diabetes undiagnosed until cancer. Rates were the highest in patients with both advanced-stage cancer and low prior primary care/medical specialist contact (breast 8.2%, colorectal 5.9%, lung 4.4%). Nonwhite race/ethnicity, living in a census tract with a higher percent of the population in poverty and a lower percent college educated, lower prior preventive services use, and lack of primary care and/or medical specialist care prior to cancer all were associated with higher adjusted odds of undiagnosed diabetes. Undiagnosed diabetes is relatively common in selected subgroups of cancer patients, including those already at high risk of poor outcomes due to advanced cancer stage.