Abstract 5409: Body mass index, type 2 diabetes, and insulin prescription in adolescents and young adults with cancer
Authors: Viskochil Richard , Holowatyj Andreana N. , Ose Dominik , Tingey Benjamin , Wilson Dalton , Larson Mikaela , Haaland Benjamin , Feltz Sara , Lewis Mark , Colman Howard , Ulrich Cornelia M. 
Published: September 2020

Abstract
Rates of obesity and obesity-related health consequences (e.g. type 2 diabetes) continue to rise. Cancer patients have increased risk of developing type 2 diabetes, however the body mass index (BMI), prevalence of type 2 diabetes, and insulin prescriptions specifically among young patients with cancer remains unknown.
Purpose: To quantify the prevalence of type 2 diabetes in adolescents and young adults (AYAs) with cancer and determine any associations between BMI, diabetes, and insulin prescription in this population from a single NCI Comprehensive Cancer Center.
Patients and methods: Using the Total Cancer Care Study (Huntsman Cancer Institute, Salt Lake City, Utah), we identified individuals ages 18 to 39 years at first primary invasive cancer diagnosis between 2009 and 2018. Clinical and demographic data, including diabetes diagnoses, insulin prescription, and cancer treatment regimens were captured from the Huntsman Cancer Registry and the University of Utah Enterprise Data warehouse. Multinomial logistic regression was used to quantify differences in body mass index (BMI) with insulin prescription within one year of cancer diagnosis. Associations between BMI and insulin prescription were assessed using both unadjusted and adjusted models.
Results: A total of 410 AYAs were diagnosed with primary invasive cancer, and 58.3% of AYAs (239/410) were overweight or obese (25+ kg/m2). Additionally, 6.3% of AYA patients were diagnosed with type 2 diabetes and 14.9% received an insulin prescription. Of those AYA patients who received an insulin prescription, over 90% (57/61, 93.4%) were prescribed insulin at or following cancer diagnosis, with over two-thirds of patients (41/57, 71.9%) receiving the prescription within one year of diagnosis. Each kg/m2 unit increase in BMI was associated with a 5% increased risk of insulin prescription within one year of cancer diagnosis (unadjusted odds ratio [OR] 1.05, 95% CI 1.01-1.10; P=0.01). This relationship persisted even after adjustment for age, sex, glucocorticoid use, chemotherapy, surgery, hormone therapy, immunotherapy and radiation therapy (adjusted OR 1.06, 95%CI 1.01-1.10; P=0.009). In the adjusted model, sex and radiation therapy were also independent predictors of being prescribed insulin. AYA men were 2.5-fold more likely to be prescribed insulin compared to women (adjusted OR 2.63, 95% CI 1.29-5.33; P=0.008).
Conclusion: Nearly two-thirds of AYAs were overweight or obese, and 1 in every 16 AYAs with cancer had type 2 diabetes. One in seven AYA patients with cancer received a prescription for insulin, and higher BMI was associated with increased risk of insulin prescription within a year of cancer diagnosis. Understanding the impact of type 2 diabetes and insulin use is critical for clinical management and interventions targeted to this population.
Citation Format: Richard Viskochil, Andreana N. Holowatyj, Dominik Ose, Benjamin Tingey, Dalton Wilson, Mikaela Larson, Benjamin Haaland, Sara Feltz, Mark Lewis, Howard Colman, Cornelia M. Ulrich. Body mass index, type 2 diabetes, and insulin prescription in adolescents and young adults with cancer [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 5409.