Oncology · Medical Literature
Assessing the Feasibility of a Self-Management Intervention for Individuals With Advanced Prostate Cancer and Comorbid Type II Diabetes Mellitus.
Abstract
Many older adults with cancer have at least one comorbidity. Type II diabetes mellitus (T2DM) is a common comorbidity among patients with prostate cancer (PC) and represents an important consideration in this population. Comorbid T2DM can negatively impact cancer-specific outcomes for patients, suggesting the need for better glycemic management, especially for patients on active cancer treatment. The goal of this modified Diabetes Self-Management Education Services (mDSMES) pilot study was to provide patients with the opportunity to learn methods of diabetes self-management, including how to manage their glucose levels, improve their understanding and utilization of medication to promote improvements in health, and optimize PC treatment outcomes. Men with comorbid T2DM and advanced-stage PC receiving androgen deprivation therapy were recruited from the cancer center and randomized to an individualized pharmacy and nutrition education and counseling intervention or a non-interventional observational group. Diabetes knowledge was assessed with a validated tool. Feasibility and acceptability were assessed through adherence and questionnaire. Laboratory assessments included serum HbA1c measurement. Among the 803 screened, 177 had T2DM, 50 were eligible, and 28 were consented and randomized. 22 men completed the study. Results show feasibility with > 75% engagement and an average acceptability questionnaire score of 37.3/56. Knowledge test scores increased among mDSMES intervention participants, and HbA1c decreased in all participants, with a continuing trend in mDSMES intervention participants not seen in SOC participants. The pilot clinical trial was feasible and acceptable, and participants gained insight and were effectively educated about T2DM self-care. A positive residual effect on HbA1c was indicated. Next steps involve refining the intervention based on provider and participant feedback and expanding it to a larger segment of the comorbid T2DM-PC population.
Clinical relevance
Comorbid Type II diabetes mellitus (T2DM) is prevalent among patients with prostate cancer (PC) — identified in 177 of 803 screened patients (22%) — and adversely impacts cancer-specific outcomes, particularly in those receiving androgen deprivation therapy (ADT), which itself worsens glycemic control. This pilot study addresses a critical gap in integrated oncology-endocrine self-management support for a vulnerable older adult population where metabolic comorbidity is routinely under-addressed during active cancer treatment. As ADT use remains a cornerstone of advanced PC management, optimizing glycemic control in this cohort has direct implications for treatment tolerability and oncologic outcomes.
Key findings
1. Of 803 screened patients, 177 (22%) had comorbid T2DM, 50 met eligibility criteria, 28 were consented and randomized, and 22 completed the study — reflecting the logistical challenges of trial enrollment in this population but confirming feasibility of the study design. 2. Feasibility threshold was met, with >75% participant engagement across the intervention arm, suggesting the modified Diabetes Self-Management Education Services (mDSMES) protocol is operationally viable in a cancer center setting. 3. Acceptability was confirmed with a mean questionnaire score of 37.3 out of 56, indicating moderate-to-good participant acceptance of the individualized pharmacy and nutrition education and counseling intervention. 4. Diabetes knowledge test scores increased among mDSMES intervention participants compared to the standard-of-care (SOC) observational group, demonstrating educational efficacy of the structured intervention. 5. Serum HbA1c decreased in all participants; however, a continuing downward trend in HbA1c was observed exclusively in the mDSMES intervention group and was not sustained in SOC participants, suggesting a positive residual glycemic benefit attributable to the intervention. 6. Specific quantitative effect sizes, confidence intervals, and p-values for HbA1c change and knowledge score improvement were not reported in the abstract, limiting precision of between-group comparisons at this pilot stage.
Practice implications
Oncology and urology clinicians managing men with advanced PC on ADT should routinely screen for comorbid T2DM — present in approximately 1 in 5 patients in this cohort — and consider referring eligible patients to integrated pharmacy and nutrition-based diabetes self-management education programs to support glycemic optimization during active cancer treatment. The mDSMES model, delivering individualized counseling on glucose monitoring, medication utilization, and dietary management, demonstrates sufficient feasibility and acceptability to justify scaling to a larger randomized trial, and should be considered as a structured adjunct to standard oncologic care rather than an isolated endocrine intervention. Until larger trials with powered efficacy endpoints are available, clinicians should at minimum ensure HbA1c monitoring is incorporated into the routine laboratory surveillance of patients with PC and comorbid T2DM receiving ADT, given the metabolic consequences of gonadal suppression on insulin resistance.