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

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). Studies have indicated that 38% of all hospitalized patients have documented hyper glycemia, and patients with new hyperglycemia have increased length of hospital stays and higher mortality (Umpierrez et al., 2002). Therefore, healthcare providers often test patients’ hemoglobin A1c (HgA1c), which measures glucose control over the previous two or three months. The test shows whether blood glucose levels are being controlled by the current treatment plan for an existing diabetes. The American Diabetes Association ([ADA], 2007) 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 lifestyle modifications of healthful eating and physical activity, as well as medication adherence and collaborative problem solving using results from home blood glucose monitoring (Weiss & Funnell, 2007). Collaborative patient plans are essential for optimal results (Funnell, Anderson, Austin, & Gillespie, 2007). Hospital-based oncology nurses face ongoing challenges in teaching patients about glycemic control through self-management. Hyperglycemia increases morbidity and mortality in hospitalized patients and increases length of stay by one to three days (Van den Berghe et al., 2001). Alterations in blood glucose levels for inpatients with cancer can impair their ability to interact with caregivers and family members, which can lead to difficulty understanding self-management of diabetes. The ADA delineated inpatient education in its 2004 position statement with specialized educators focusing on diabetes education (Clement et al., 2004; Mensing et al., 2004) (see Figure 1). Figure 1 Predischarge Instructions Oncology nurses routinely provide patients and families with information about cancer (e.g., when to call a healthcare provider, signs and symptoms of a fever, ways to manage symptoms), but they also should educate them about prevention, recognition, and treatment of hypoglycemia and hyperglycemia. To provide oncology nurses with a foundation for inpatient diabetes education, this article reviews the pathophysiology of diabetes in patients with cancer and aspects of current diabetes self-management education (DSME): empowerment-based approaches and motivational interviewing.