Detection and management of hyperglycaemia in oncology patients receiving systemic anti-cancer therapy
Authors: L. Morrison, R. Gillmore, R. Pierce
Journal: Annals of Oncology (2018)

Introduction: Hyperglycaemia is a significant cause of morbidity in cancer patients accounting for up to 5% of emergency oncology admissions (1). The incidence of hyperglycaemia in non-diabetic patients receiving anti-cancer therapy has been shown to be as high as 11.6% (2). One significant factor is the high doses of steroids administered either as part of the systemic anti-cancer treatment to control nausea and vomiting, or to palliate other cancer-related symptoms such as pain or anorexia. Patients with gastro-intestinal (GI) malignancies, in particular, often receive high doses of steroids as part of their chemotherapy regimens eg for bowel cancer FOLFOX, FOLFIRI and FOLFOXIRI treatments, platinum-containing regimes for patients with upper GI cancers and for the pancreas population FOLFIRINOX treatment. There is currently no consensus regarding blood glucose level (BGL) monitoring in patients receiving anti-cancer treatments. We therefore carried out a prospective audit aiming to identify the prevalence of abnormal blood sugars using random capillary blood glucose measurements. Methods: During a three-week period, all patients attending the oncology outpatient clinic for systemic anti-cancer treatments had their blood sugar checked using a capillary blood glucose machine. The rationale for using BGL is that it can be more reliable than HBA1C in patients with anaemia or in those who have recently been commenced on steroids (3). Blood glucose diagnostic cut off figures were used as per diabetes UK guidelines for normal, borderline diabetic, diabetic values. Information on primary tumour type, anti-cancer treatment, cycle number, steroid dose and pre-existing diabetic diagnosis were collected. Results: A total of 166 patients had their BGL checked during the time period. 18 (11%) had a blood sugar diagnostic of diabetes mellitus (DM), 25 (15%) had a borderline blood sugar and 123 (74%) patients had normal blood sugars. Of the 43 patients with an abnormal result 24 (56%) were NOT known to have diabetes. Furthermore, in the group with blood sugars diagnostic of diabetes 4 (22%) were NOT known to be diabetic and in the borderline group 20 (80%) were NOT known to have diabetes. One patient was admitted to hospital as a direct result of the BGL measurement during this audit. The highest proportion of abnormal results was in the GI cancer group (24% of the total cohort). Within this cohort 20% had malignancies of pancreatic origin and 80% were colorectal in origin. Treatment regimens included FOLFOX (80%) and FOLFIRI (20%). Conclusion: 10 (27%) GI patients and 43 (25.8%) of all oncology patients tested had abnormal blood sugars showing either high risk of developing or consistent with a diagnosis of DM. All of these patients were receiving steroids as part of their anti-cancer treatments. NICE advocate frequent monitoring of all patients on high dose steroids. We suggest that routine BGL monitoring of all patients on systemic anti-cancer therapy and early liaison with the local diabetes team could prevent unnecessary hospital admission and reduce associated morbidity. As well as one direct admission during this audit, 9 oncology patients were admitted to our unit over a twelve-month period with complications related to hyperglycaemia.