There is little data regarding the risk factors for, prevalence of, and outcomes of treatment in patients who experience dysglycaemia during glucocorticoid-based chemotherapy for malignancy, as opposed to those who remain normoglycaemic.
In this retrospective observational study, all patients prescribed intravenous or oral dexamethasone through the Barwon South West Intergated Cancer Services for a malignant haematological condition between January 1 and December 31 2009 were screened for inclusion [n=88]. Patients lacking glucose measurements during glucocorticoid treatment were excluded [n=25], leaving 63 patients for inclusion in this analysis.
There were 19 diffuse large B-cell lymphomas [DLBCL] [30%], 14 multiple myeloma [22%], 18 Hodgkin's and non-Hodgkin's lymphomas, 11 leukaemias [acute myeloid, acute lymphoblastic, chronic lymphocytic, hairy cell], and 1 myeloid sarcoma. The median age was 60 [range, 24-85] and 68% were male.
Pre-glucocorticoid glycaemic status was known in 52 patients of whom 25 were normal, 12 had diabetes and 15 had impaired fasting glucose [IFG] or impaired glucose tolerance [IGT]. Of those with IFG/IGT, only one patient had formal documentation of this in their medical history prior to chemotherapy and 6/12 patients with diabetes did not have a diabetes diagnosis or acknowledgement of abnormal glucose metabolism in their medical record. Of the 41 patients without diabetes and documented pre-glucocorticoid glycaemic status, 73% experienced a deterioration in glycaemic status, unaffected by age. Dysglycaemia during therapy occurred in 82.5% of whom only 30% were treated.
At 12 months post first dose of glucocorticoid, there were 8 deaths [13%], 51 were alive, and vital status was unknown in 4 cases. Abnormal glucose tolerance was present in 87.5% of the deceased and 80.4% of the survivors.
Among patients with haematological malignancy in this small, heterogeneous sample, dysglycaemia prior to glucocorticoid therapy is under-recognised and glucocorticoid therapy leads to significant rates of dysglycaemia. Outcome analyses of a larger group are ongoing.