Abstract P1-20-02: Incidence of hyperglycemia in non-diabetic patients with early-stage breast cancer treated with chemotherapy
Authors: Accordino MK , Lin A , Wright JD , Trivedi MS , Kalinsky K , Crew KD , Hershman DL 
Published: May 2019

Background: There are shared risk factors between breast cancer (BC) and diabetes mellitus (DM). BC treatments including chemotherapy given in combination with glucocorticoids can induce hyperglycemia and steroid related DM. Patients with DM are at increased risk of developing chemotherapy related toxicities such as chemotherapy induced peripheral neuropathy (CIPN) compared to those without DM. The incidence of hyperglycemia during chemotherapy in non-diabetic patients with early-stage breast cancer is unknown.

Methods: We performed a retrospective analysis of non-diabetic women with stage I-III breast cancer treated with chemotherapy at Columbia University Medical Center from 9/1/2016-8/31/2017 to evaluate hyperglycemia incidence during chemotherapy and up to six months after chemotherapy completion. Eligible patients were identified in the electronic health record (EHR) by ICD9 and 10 codes (ICD9 174.x and ICD10 C50.x) and a record of chemotherapy administration. Non-diabetic patients were defined by chart review as no recorded history of diabetes and no receipt of a diabetes medication in the EHR. Breast cancer stage was determined by chart review. Glucose values were recorded prior to chemotherapy, during chemotherapy, and for six-months after chemotherapy completion. We defined hyperglycemia as a glucose value of ≥200 mg/dl. Median time to hyperglycemia was also calculated.

Results: We identified 82 eligible patients. The majority of patients received dexamethasone during their chemotherapy course (79 patients, 96.3%). The most frequent chemotherapy regimen was doxorubicin/cyclophosphamide and paclitaxel (32 patients, 39.0%). At baseline, 20 patients (24.4%) had a normal body mass index (BMI), 27 patients (32.9%) were overweight, and 31 patients (37.8%) were obese. Hyperglycemia occurred in 8 patients (9.8%) after initiation of chemotherapy. Among patients with hyperglycemia, the maximum blood glucose was between 200-299 mg/dl in seven patients (87.5%), and between 500-599 in one patient (12.5%). The median time to hyperglycemia was 84 days. Among patients who did not experience hyperglycemia, the maximum blood glucose was between 140-159 mg/dl in six patients (8.1%), between 160-179 mg/dl in eight patients (10.8%), and between 180-199 mg/dl in three patients (4.1%). Three patients were diagnosed with DM following chemotherapy completion.

Conclusion: Hyperglycemia occurred in almost 10% of non-diabetic patients who received chemotherapy for early-stage breast cancer. Additionally, over 30% of patients had a blood glucose of 140 mg/dl or higher after chemotherapy initiation. The impact of hyperglycemia on the development of chemotherapy related toxicities in this group is unknown. Future research is needed to identify effective interventions for glucose control during chemotherapy, and to determine if glucose control during treatment can reduce the risk of chemotherapy related toxicities, specifically CIPN.

Citation Format: Accordino MK, Lin A, Wright JD, Trivedi MS, Kalinsky K, Crew KD, Hershman DL. Incidence of hyperglycemia in non-diabetic patients with early-stage breast cancer treated with chemotherapy [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-20-02.