Glycaemic control guidance issued for those with diabetes and cancer
Guidance for oncology and haemato-oncology multidisciplinary teams has been issued so they are better equipped at advising people with diabetes who are about to start anti-cancer or glucocorticoid (GC) therapy.
Entitled ‘The Management of Glycaemic Control in Patients with Cancer‘, the guidelines have been published by the UK Chemotherapy Board and the Joint British Diabetes Societies for Inpatient Care (JBDS-IP).
It is thought that 20 per cent of people with cancer already have an underlying diagnosis of diabetes and having cancer also increases the risk of diabetes and hyperglycaemia.
In addition, people with diabetes undergoing oncology and haemato-oncology treatments are also at an increased risk of toxicities, hospital admissions and morbidity, with hyperglycaemia potentially attenuating the efficacy of chemotherapy often secondary to dose reductions and early cessation.
Numerous studies have demonstrated that hyperglycaemia is prognostic of worse overall survival and risk of cancer recurrence.
A small clinical study of 88 people with oestrogen-receptor positive breast cancer found that hyperglycaemia induced chemo-resistance, with impaired glucose tolerance significantly correlated with disease progression in those receiving chemotherapy.
Similarly, high blood glucose levels, regardless of a diagnosis of diabetes, were shown to significantly enhance oxaliplatin chemo-resistance in people with stage III colorectal cancer receiving fluorouracil and oxaliplatin (FOLFOX) chemotherapy.
Principle author of the document Dr Nalinie Joharatnam-Hogan said: “These studies highlight the importance of adequate glycaemic control during treatment for cancer to potentially improve outcomes.
“We know that about one in 5 people who are receiving cancer treatment also have diabetes, or high blood sugar. Some cancer treatments, and other supportive treatments (including steroids) can raise blood sugar. This may lead to a worsening of the person’s blood sugar control which is why we need to ensure all involved teams are fully aware of the signs and feel confident enough in taking swift action before the condition worsens.
“Keeping blood sugar levels under good control during cancer treatment has been shown to reduce the risk of infections and other side effects from cancer treatment, improve overall wellbeing and increase the effectiveness of the cancer treatment.”
The document also includes a patient information sheet for those who have diabetes and are starting anti-cancer treatment and downloadable communication aids so hospitals can add local information as required.
To read the guidance, click here.