Abstract B130: Feasibility metric outcomes: A nurse-led intervention to identify and manage undiagnosed type 2 diabetes in patients with newly diagnosed cancer
Authors: Scarton Lisa , Nelson Tarah , Yao Yingwei , Huggins Shavondra , Jo Ara , O'Neal LaToya J. , George Thomas J. , Munoz-Pena Juan M. , Markham Merry J. , Murphy Martina C. , Chatzkel Jonathan A. , Rogers Sherise 
Published: January 2023

Abstract
Background: Each year 1.4 million adults are diagnosed with diabetes, and in 2022 more than 1.9 million Americans will be diagnosed with cancer. There is a strong link between type 2 diabetes (T2D) and several types of cancer, and both conditions are known for health disparities. Unrecognized or poorly managed T2D is associated with higher staged cancer at diagnosis and cancer mortality rates with reduced overall survival. Yet, it is not standard oncology practice to test newly diagnosed cancer patients for T2D. Nurses are well positioned to facilitate testing and management of T2D.Aim: The purpose of this study was to examine the feasibility of a nurse-led intervention for adults with newly diagnosed cancer and undiagnosed T2D.Method: In a randomized feasibility pilot study conducted within a large academic medical oncology center, we used EPIC to identify adults with newly diagnosed cancer (&lt; 3 months). The intervention group received immediate initiation of metformin and T2D management education. The standard care group received referral back to their primary care provider. The study measures included HbA1c and feasibility metrics (i.e., population availability, recruitment efficiency and sample retention).Results: Two days a week, over an 11-month timeframe, we pre-screened 379 adults (78.4% non-Hispanic White, 12.9% Black, 1.6% Asian, .5% American Indian, 7.1% other) for study eligibility. Of those pre-screened only 55 (14.5%) patients were eligible for HbA1c screening. The rest were excluded due to current use of metformin (16%), abnormal labs (AST/ALT, eGFR) (16%), or poor prognosis (e.g., pancreatic cancer or leukemia; 18%). Of the 55 patients screened, one non-Hispanic White man, one non-Hispanic White woman, and one Black woman met HbA1c ≥ 6.5% eligibility for the intervention (mean age 58.3, two patients had breast cancer and one patient had rectal cancer); one patient was randomized to the intervention group and two patients were randomized to the standard care group. The initial HbA1c for the intervention group patient was 6.7% and decreased to 5.1% after 3 months (primary endpoint). For the two standard care group patients, the HbA1c was 7.2% and 6.7% and decreased to 5.5%, 5.9%, respectively, after 3 months. No patients were lost to follow-up. All three patients indicated that they enjoyed participating in the study, the length of the study was good, and felt the study would be well received by other patients. The study was subsequently closed due to failing feasibility metrics. Conclusion: Despite study acceptability to patient, this T2D screening protocol was deemed not feasible due to recruitment inefficiency including cost, time, and personnel to screen at the point of care. Integrating routine HbA1c tests for all newly diagnosed cancer patients would simplify screening for study, which would allow another feasibility study of a promising intervention to improve management of undiagnosed T2D among newly diagnosed patients with cancer.
Citation Format: Lisa Scarton, Tarah Nelson, Yingwei Yao, Shavondra Huggins, Ara Jo, LaToya J. O'Neal, Thomas J. George, Juan M. Munoz-Pena, Merry J. Markham, Martina C. Murphy, Jonathan A. Chatzkel, Sherise Rogers. Feasibility metric outcomes: A nurse-led intervention to identify and manage undiagnosed type 2 diabetes in patients with newly diagnosed cancer [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr B130.