Poster Presentation Australian Diabetes Society and the Australian Diabetes Educators Association Annual Scientific Meeting 2014

Hyperglycaemia in glucocorticoid-based chemotherapy for haematological malignancies. (#342)

Shannon E McCarthy 1 , David M Ashley 2 3 , Mark A Kotowicz 1 2
  1. Department of Endocrinology & Diabetes, Barwon Health, Geelong, VIC, Australia
  2. Deakin University School of Medicine, Department of Medicine, Barwon Health, Geelong, VIC, Australia
  3. Andrew Love Cancer Centre, Barwon Health, Geelong, VIC, Australia

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.

  1. Uzu T, Harada T, Sakaguchi M, Kanasaki M, Isshiki K, Araki S, Sugiomoto T, Koya D, Haneda M, Kashiwagi A, Yamauchi A. Glucocorticoid-induced diabetes mellitus: prevalence and risk factors in primary renal diseases. Nephron Clin Pract. 2007;105(2):c54-7.
  2. Iwamoto T, Kagawa Y, Naito Y, Kuzuhara S, Kojima M. Steroid-induced diabetes mellitus and related risk factors in patients with neurologic diseases. Pharmacotherapy. 2004 Apr;24(4):508-14.
  3. Kim SY, Yoo CG, Lee CT, Chung HS, Kim YW, Han SK, Shim YS, Yim JJ. Incidence and risk factors of steroid-induced diabetes in patients with respiratory disease. J Korean Med Sci. 2011 Feb;26(2):264-7.
  4. Robertson et al. Clinical consequences of hyperglycemia during remission induction therapy for pediatric acute lymphoblastic leukemia. Leukemia. 2009 February ; 23(2): 245-250.
  5. Baker EH, Janaway CH, Philips BJ, Brennan AL, Baines DL, Wood DM, Jones PW. Hyperglycaemia is associated with poor outcomes in patients admitted to hospital with acute exacerbations of chronic obstructive pulmonary disease. Thorax. 2006 Apr;61(4):284-9. Epub 2006 Jan 31.
  6. Capes SE, Hunt D, Malmberg K, Gerstein HC. Stress hyperglycaemia and increased risk of death after myocardial infarction in patients with and without diabetes: a systematic overview. Lancet. 2000 Mar 4; 355(9206):773-8.
  7. Capes SE, Hunt D, Malmberg K, Pathak P, Gerstein HC. Stress hyperglycemia and prognosis of stroke in nondiabetic and diabetic patients: a systematic overview. Stroke. 2001 Oct; 32(10):2426-32.
  8. Lowas SR, Marks D, Malempati S. Prevalence of transient hyperglycemia during induction chemotherapy for pediatric acute lymphoblastic leukemia. Pediatr Blood Cancer. 2009 Jul;52(7):814-8.
  9. Hyperglycemia: an independent marker of in-hospital mortality in patients with undiagnosed diabetes. J Clin Endocrinol Metab. 2002 Mar;87(3):978-82.