Type 2 diabetes was associated with greater risks of anemia and infection in survivors of colorectal cancer, according to the results of a new study published in the journal Oncology Nursing Forum.

In this retrospective study, the researchers used an electronic health record database to identify 3287 survivors of colorectal cancer who were treated at a hospital system based in the Midwestern United States. The researchers evaluated outcomes and healthcare utilization for survivors aged 21 years or older who had stage II or III colorectal cancer, with comparisons based on presence or absence of a type 2 diabetes diagnosis prior to the cancer diagnosis.

A total of 655 survivors in this study had type 2 diabetes, 2632 did not, for a rate of approximately 20% with diabetes. Multivariable analyses revealed that the presence of type 2 diabetes was associated with an increased likelihood of anemia in this population (odds ratio, 1.45; 95% CI, 1.04-2.01). Infections also occurred more often in participants with diabetes (odds ratio, 2.09; 95% CI, 1.71-2.56) than in those without the disease. However, diabetes was not associated with an increased risk of neutropenia in this population.

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An analysis of healthcare utilization showed a slightly greater likelihood of survivors with diabetes using emergency department (ED) resources compared with those without diabetes (hazard ratio, 1.11; 95% CI, 1.01-1.21).

The researchers concluded that diabetes was associated with risks of anemia and infection and a higher rate of ED visits in this study population. Presence of diarrhea, dehydration, smoking history, and female sex were also identified as risk factors for some outcomes assessed in this study.

“Oncology nurses’ understanding of the contribution of comorbid diabetes to poor outcomes in individuals with colorectal cancer can inform the development of proactive assessment, intervention, monitoring, and treatment strategies, improving clinical outcomes and reducing the utilization of healthcare resources,” the researchers wrote in their report.


Storey S, Zhang Z, Luo X, et al. Association of comorbid diabetes with clinical outcomes and healthcare utilization in colorectal cancer survivors. Oncol Nurs Forum. 2021;48(2):195-206. doi:10.1188/21.ONF.195-206