Incidence of diabetes and hyperglycemia among patients receiving glucocorticoids with chemotherapy.

Abstract

286 Background: Over 30 million adults in the U.S. have diabetes (DM), 7 million of which are undiagnosed. Patients with DM undergoing cancer treatment have been shown to have increased rates of complications and shorter survival. Patients commonly receive glucocorticoids (GC) with chemotherapy (CT), which may lead to hyperglycemia. Data regarding the optimal approach to screening and outpatient management of patients receiving CT with GC is lacking. We sought to describe the incidence of diabetes, hyperglycemia, and implemented a quality improvement project to refer eligible patients for DM education and management. Methods: We identified 100 patients with cancer starting a new CT regimen including GC. We obtained screening labs, baseline random glucose, HbA1c, and body-mass index (BMI) for each patient prior to starting CT. Follow-up glucose values were obtained with each cycle; patients were followed for a maximum of 3 cycles of CT. Patients with a baseline HbA1c ≥6.5%, a baseline random glucose ≥200mg/dL, follow up glucose ≥200mg/dL, and/or a prior DM diagnosis were referred to the Park Nicollet International Diabetes Center (IDC) to receive DM education and management. Results: 23% of patients had known DM and 17% had known prediabetes prior to their first CT cycle. Baseline HbA1c values were ≥6.5% in 18% of patients, 5.7-6.4% in 39% of patients, and ≤5.6% in 43% of patients. Among the 18 patients with baseline HbA1c ≥6.5%, 13 had known DM, 1 had known prediabetes, and 4 were undiagnosed. 67% of our study population had a baseline BMI ≥25. 12 patients had at least one follow up glucose ≥200mg/dL. Of those 12, 92% had known DM, 67% had a baseline HbA1c ≥6.5%, and 75% had a baseline BMI ≥25. 29 patients met IDC referral criteria, however, only 14 were ultimately seen in consultation. Conclusions: Adding HbA1c to baseline laboratory evaluations identified individuals with undiagnosed DM. DM history, baseline HbA1c, and BMI were associated with hyperglycemic events among patients receiving CT with GC. Future studies are needed to evaluate the impact of DM education and management on both glycemic control and clinical outcomes.