Guidelines have been issued for multidisciplinary oncology and hemato-oncology teams to better advise people with diabetes who are about to begin cancer or glucocorticoid (GC) therapy.
The guidelines, entitled “Management of Blood Glucose Control in Cancer Patients,” have been published by the UK Chemotherapy Board and the Joint British Diabetes Societies for Inpatient Care (JBDS-IP).
It is believed that 20 percent of people with cancer already have an underlying diagnosis of diabetes and that cancer also increases the risk of diabetes and hyperglycemia.
In addition, people with diabetes undergoing oncological and haemato-oncological treatment are at increased risk of toxicities, hospital admissions, and morbidity, with hyperglycemia potentially making chemotherapy less effective, often due to dose reduction and early discontinuation .
Numerous studies have shown that hyperglycemia is a prognosis for poor overall survival and the risk of cancer recurrence.
A small clinical study of 88 people with estrogen receptor positive breast cancer found that hyperglycemia induced chemoresistance, with impaired glucose tolerance correlating significantly with disease progression in those who received chemotherapy.
Similarly, regardless of a diagnosis of diabetes, high blood sugar levels have been shown to significantly improve oxaliplatin chemoresistance in people with stage III colon cancer receiving chemotherapy with fluorouracil and oxaliplatin (FOLFOX).
The main author of the document, Dr. Nalinie Joharatnam-Hogan said, “These studies highlight the importance of adequate glycemic control during cancer treatment to potentially improve outcomes.
“We know that about one in five people who receive cancer treatment also have diabetes or high blood sugar. Some cancer treatments and other supportive treatments (including steroids) can increase blood sugar. This can lead to a deterioration in the person’s blood sugar control. So we need to make sure all teams involved are fully aware of the signs and feel confident enough to take action quickly before the condition worsens.
“Good control of blood sugar levels during cancer treatment has been shown to reduce the risk of infection and other side effects of cancer treatment, improve overall well-being, and make cancer treatment more effective.”
The document also includes a patient information sheet for people with diabetes starting cancer treatment, as well as downloadable communication aids for hospitals to add local information as needed.
Click here to read the guide.