Hyperglycaemia in cancer treatment: A prospective cohort study

Abstract

Aim: Many anti-cancer treatments are known to increase the risk of hyperglycaemia, even in individuals without a previous diagnosis of diabetes mellitus (DM). This study aims to: 1) explore the prevalence of DM in people receiving systemic anti-cancer therapy (SACT) in the ambulatory setting, 2) explore whether administration of long term SACT (≥3 months) causes changes in blood glucose levels in people who have underlying DM or in people undiagnosed with DM, and 3) explore referral patterns for management of DM according to an established referral pathway.

Methods: This is a prospective, single centre, cohort study. Eligibility includes people receiving SACT in the ambulatory setting (intravenous and/or oral anti-cancer treatment). Participants completed a HbA1c (glycated haemoglobin) at baseline (commencement of SACT) and at 3-months. Demographics and clinical/disease characteristics were collected from participants’ electronic medical records and entered into REDCAp.

Results: Eligible individuals were recruited from Feb 2023 - May 2023, with 120 patients completing the baseline HbA1c and 90 patients completing follow-up HbA1c at 3-months. At baseline, 11% (n = 13) patients had a HbA1c result ≥ 6.5%, with 46% (n = 6) having a pre-existing diagnosis of DM. 64% (n = 53) of patients received glucorticosteroids as a part of their anti-cancer regimen or supportive care. At 3-months, 8 patients (9%) had a HbA1c ≥ 6.5%, with 2 developing DM after commencing SACT. 38% (n = 5) of patients were referred to their GP for diabetes management, with none requiring referral to endocrinology. After 3 months of receiving SACT, 9% (n=8) patients newly became pre-diabetes (HbA1c 6.0% - 6.4%).

Conclusion: Eleven per cent of patients had DM, with 46% having not previously received a DM diagnosis. Further research is needed to establish whether individuals receiving SACT are at increased risk of developing DM.

Impact: These findings will assist the multidisciplinary team in refining processes for early detection of DM and pathways to direct management of hyperglycaemia in cancer patients whilst receiving SACT.