Glucocorticoid-induced hyperglycemia in oncohematological patients

Abstract

Background Glucocorticoids are a common component of systemic chemotherapy regimens for hematological malignancy. Steroid-induced hyperglycemia remains a common potentially harmful problem that must be considered when using any type of glucocorticoids. Little is known about the impact of hyperglycemia associated with steroid use on treatment morbidity, infectious complications, as well as disease remission and mortality. Objective The aim of the current work is to study glucocorticoid-induced hyperglycemia in patients with hematologic malignancies receiving repeated short-term pulse cycles of glucocorticoids (5–7 days), to estimate its prevalence, to define the risk factors, and to assess treatment response. Patients and methods The prospective study included 30 adult patients with acute lymphoblastic leukemia, non-Hodgkin’s lymphoma, and chronic lymphocytic leukemia attending the outpatient clinic of Al Hussein Hospital, Al Azhar University during the period between November 2015 and April 2016. During the period of the study, 30 patients received a total of 60 cycles of chemotherapy including corticosteroid. Results Out of the 30 study patients, 15 (50%) were men and 15 (50%) were women with a mean age of 44.17. Corticosteroid-induced hyperglycemia was documented in 12 patients after one or more than one cycle (12/30–40%). Among the 60 cycles, corticosteroid-induced hyperglycemia was documented after 19 cycles (19/60–31%). The age of the patient was found to be the most important factor that affected the occurrence of hyperglycemia after corticosteroid where younger patients were less likely to develop hyperglycemia (P=0.013). Patients with BMI less than or equal to 25 had the lowest chance to develop hyperglycemia after corticosteroid. However, this difference was not statistically significant. The three patients who developed persistent hyperglycemia received hypoglycemic medications. Conclusion About one-third of patients with hematological malignancies receiving glucocorticoids may develop hyperglycemia. To allow for early detection and effective treatment, these patients should be screened for hyperglycemia at least before each cycle and 4–6 h after glucocorticoids intake, especially old obese patients Appropriate guidelines for the diagnosis and treatment of steroid-induced diabetes are needed in order to prevent complications associated with the hyperglycemic state