An integrated care pathway for cancer patients with diabetes: A proposal from the Italian experience


      Diabetes and cancer frequently coexist in the same subject, often with relevant clinical effects on the management and prognosis of the comorbid patient. The existing guidelines, however, do not appropriately address many clinical issues in this setting. Although collaboration between diabetologists and oncologists should play an important role in achieving appropriate levels of care, close coordination or agreement between these specialists is seldom offered. There is an urgent need for greater interdisciplinary integration between all specialists involved in this setting, for a shared approach ensuring that organisational silos are overcome. To this end, the Italian Associations of Medical Diabetologists (AMD) and the Italian Association of Medical Oncology (AIOM) recently established a dedicated Working Group on ‘Diabetes and Cancer’. The working group outlined a diagnostic and therapeutic clinical pathway dedicated to hospitalised patients with diabetes and cancer. In this article, we describe the Italian proposal including some suggested measures to assess, monitor and improve blood glucose control in the hospital setting, to integrate different specialists from both areas, as well as to ensure discharge planning and continuity of care from the hospital to the territory.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Diabetes Research and Clinical Practice
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Vigneri P.
        • Frasca F.
        • Sciacca L.
        • Pandini G.
        • Vigneri R.
        Diabetes and cancer.
        Endocr Relat Cancer. 2009; 16: 1103-1123
        • Psarakis H.M.
        Clinical challenges in caring for patients with diabetes and cancer.
        Diabetes Spectrum. 2006; 19: 157-162
        • Barone B.B.
        • Yeh H.C.
        • Snyder C.F.
        • et al.
        Long-term all-cause mortality in cancer patients with preexisting diabetes mellitus: a systematic review and meta-analysis.
        JAMA. 2008; 300: 2754-2764
        • Ballotari P.
        • Vicentini M.
        • Manicardi V.
        • Gallo M.
        • Chiatamone Ranieri S.
        • Greci M.
        • et al.
        Diabetes and risk of cancer incidence: results from a population-based cohort study in northern Italy.
        BMC Cancer. 2017; 17: 703
        • Sacerdote C.
        • Ricceri F.
        Epidemiological dimensions of the association between type 2 diabetes and cancer: A review of observational studies.
        Diabetes Res Clin Pract. 2018; 143: 369-377
        • Cignarelli A.
        • Genchi V.A.
        • Caruso I.
        • Natalicchio A.
        • Perrini S.
        • Laviola L.
        • et al.
        Diabetes and cancer: Pathophysiological fundamentals of a 'dangerous affair'.
        Diabetes Res Clin Pract. 2018; 143: 378-388
        • Ranc K.
        • Jørgensen M.E.
        • Friis S.
        • Carstensen B.
        Mortality after cancer among patients with diabetes mellitus: effect of diabetes duration and treatment.
        Diabetologia. 2014; 57: 927-934
        • King E.J.
        • Haboubi H.
        • Evans D.
        • Baker I.
        • Bain S.C.
        • Stephens J.W.
        The management of diabetes in terminal illness related to cancer.
        QJM. 2012; 105: 3-9
        • Ford-Dunn S.
        • Quin J.
        Management of diabetes in the terminal phase of life.
        Pract Diab Int. 2004; 21: 175-176
        • McCoubrie R.
        • Jeffrey D.
        • Paton C.
        • Dawes L.
        Managing diabetes mellitus in patients with advanced cancer: a case note audit and guidelines.
        Eur J Cancer Care. 2005; 14: 244-248
        • Quinn K.
        • Hudson P.
        • Dunning T.
        Diabetes management in patients receiving palliative care.
        J Pain Symptom Manage. 2006; 32: 275-286
        • Handelsman Y.
        • Leroith D.
        • Bloomgarden Z.T.
        • Dagogo-Jack S.
        • Einhorn D.
        • Garber A.J.
        • et al.
        Diabetes and cancer - an AACE/ACE consensus statement.
        Endocr Pract. 2013; 19: 675-693
        • Gallo M.
        • Muscogiuri G.
        • Felicetti F.
        • Faggiano A.
        • Trimarchi F.
        • Arvat E.
        • et al.
        Adverse glycaemic effects of cancer therapy: indications for a rational approach to cancer patients with diabetes.
        Metabolism. 2018; 78: 141-154
      1. AMD-SID. Standard italiani per la cura del diabete mellito 2018. [accessed February 2019].

      2. NHS – Pan Birmingham Cancer Network. Guideline for the Management of Diabetes Mellitus in Palliative Medicine. [accessed February 2019].

      3. Mateo J, Castro E, Olmos D, on behalf of the European Society for Medical Oncology. Cancer treatment in patients with diabetes. From: 2013 ESMO Handbook on Cancer Treatment in Special Clinical Situations: 72–88. Edit. ESMO Press.

        • Gallo M.
        • Gentile L.
        • Arvat E.
        • Bertetto O.
        • Clemente G.
        Diabetology and oncology meet in a network model: union is strength.
        Acta Diabetol. 2016; 53: 515-524
      4. AMD-AIOM Working Group on “Diabetes and Cancer”. [accessed February 2019].

      5. Clemente G, Giorgini M, Mancini M, Gallo M, on behalf of the AMD ‘Diabetes and Cancer’ working group. Diabetologists and Oncologists attitudes towards treating diabetes in the oncologic patient: insights from an exploratory survey. Diabetes Res Clin Pract 2018;143:420–7.

      6. Rete Oncologica Piemonte-Valle d’Aosta. Protocollo per la gestione del paziente oncologico con diabete mellito. [accessed February 2019].