Oncology and glucose-related emergencies the focus of latest updated JBDS guidelines
Newly updated guidance from the Joint British Diabetes Societies for Inpatient Care (JBDS-IP) has been published, providing further recommendations for healthcare professionals caring for people with diabetes.
The Management of Glycaemic Control in People with Cancer: Guidance for the oncology and diabetes multidisciplinary team
This report, on behalf of the UK Chemotherapy Board and JBDS, aims to provide the oncology/haemato-oncology multidisciplinary team with the advice to manage people with diabetes commencing anti-cancer/glucocorticoid therapy, as well as identifying individuals without a known diagnosis of diabetes who are at risk of developing hyperglycaemia and new onset diabetes.
The report says: “Individuals with cancer are at increased risk of developing new onset diabetes mellitus and hyperglycaemia, and an estimated 20% of people with cancer already have an underlying diagnosis of diabetes mellitus.
“People with both cancer and diabetes may have 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.
The guidelines include the management of hyperglycaemia in oncology patients on cancer therapy without a previous diagnosis of diabetes, and commencing systemic anti-cancer therapy (SACT) in a person with pre-existing diabetes.
There are also dietetic recommendations and the following pathways:
- Commencing anti-cancer therapy/ glucocorticoids in cancer patients without a previous diagnosis of diabetes
- Commencing immune checkpoint inhibitors in cancer patients without a previous diagnosis of diabetes
- Commencing SACT/ glucocorticoid therapy in cancer patients with type II diabetes on oral glucose lowering agents
- Commencing SACT/ glucocorticoid therapy in cancer patients with diabetes treated with insulin
Diabetes at the Front Door: A guideline for dealing with glucose related emergencies at the time of acute hospital admission
This latest guidance aims to provide a quick guide to triage when adults with diabetes attend acute emergency departments and emergency decision units for diabetes specific problems.
June James, Diabetes Nurse Consultant at University Hospitals of Leicester NHS Trust, said: “People with diabetes account for nearly a fifth of all inpatients in English and Welsh hospitals; of these, up to ninety percent are admitted as an emergency. Most are admitted for a reason other than diabetes with only eight percent requiring admission for a diabetes specific cause.
“Healthcare professionals working “at the coalface” experience numerous clinical challenges, notwithstanding the need to know whether each individual with diabetes requires urgent admission. This document has been developed by experts in the field and aims to support staff by offering practical advice and tools for effective, appropriate and safe triage.”
The guidelines include:
- Hyperglycaemic emergencies, Hyperglycaemia, Diabetic Ketoacidosis, Hyperosmolar Hyperglycaemic State
- An example pathway to decide whether someone presenting with hypoglycaemia needs acute hospital admission or not
- The treatment of hypoglycaemia
- Diabetes assessment in people with known and unknown previous diagnosis of diabetes
- Diabetes decision support tool: Management of hyperglycaemia
View the updated guidelines here.