Cancer patients with undiagnosed and poorly managed diabetes mellitus.

Kim, Sooha; Garg, Anukul; Raja, Fharat

doi:10.1200/jco.2017.35.15_suppl.e18232

Cited by 2 publications

(1 citation statement)

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“…Some individuals will prefer cold meals if they are nauseated. Difficulty in swallowing can be a challenge, and if so the taking of oral blood glucose lowering therapies is more difficult; repaglinide, a very short acting medication, can be used in those with type 2 diabetes or low dose insulin in people with type 1 and in type 2 diabetes 19 . Food supplements in the form of juices may contain high levels of glucose and are best avoided.…”

Section: Special Groups With Comorbiditiesmentioning

confidence: 99%

Dying, dignity and diabetes

James

2021

Practical Diabetes

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In 2019, the International Diabetes Federation attributed 4.2 million deaths due to diabetes. 1 In the United States, diabetes was said to be the seventh leading cause of death in 2017; this information was based on over 83,000 death certificates. 2 Over half a million people died in the United Kingdom 3 in 2017 and, in the same year, 117,000 of these individuals had diabetes. 4 The cause of death in these individuals is not usually attributed to acute diabetes complications such as diabetic ketoacidosis (DKA), hyperosmolar hyperglycaemic state (HHS) or hypoglycaemia, but to the long-term complications which occur in individuals living with the condition such as cardiovascular disease, chronic kidney disease and dementia or respiratory disease or cancer. A holistic approach to the care of people living with diabetes as they near the end of their lives is important if acute metabolic complications, unnecessary treatment regimens and excessive monitoring are to be avoided. 5 Individuals with diabetes will undoubtedly face additional psychological and clinical challenges as they enter end of life care. This article takes a practical approach to end of life care in people with diabetes; it includes national and international recommendations and simple algorithms developed to support health care professionals caring for these individuals.

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Section: Special Groups With Comorbiditiesmentioning

confidence: 99%

Dying, dignity and diabetes

James

2021

Practical Diabetes

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Optimal hyperglycemia thresholds in patients undergoing chemotherapy: a cross sectional study of oncologists’ practices

Salgado,

Birari,

Alshahawey

et al. 2024

Support Care Cancer

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Purpose Neither the United States nor the European oncology guidelines include details for appropriate management of hyperglycemia in cancer patients. The aim was to identify fasting and random blood glucose thresholds, and hemoglobin A1c (HbA1c) targets used by oncologists in clinical practice when managing hyperglycemia in patients with cancer undergoing chemotherapy. Methods This national, cross sectional study utilized a questionnaire to collect oncologists’ perceptions about optimal blood glucose thresholds and HbA1c targets in patients with cancer undergoing chemotherapy. Descriptive statistics were calculated to summarize glucose thresholds, HbA1c targets, and sample characteristics. Responses to an open-ended question about oncologists’ approach to hyperglycemia management were analyzed via thematic analysis using an inductive approach. Results Respondents (n = 229) were on average 52.1 years of age, 67.7% men, and 91.3% White. For patients without diabetes but experiencing hyperglycemia, oncologists targeted lower and upper fasting blood glucose levels between 75-121 mg/dL and 105-135 mg/dL, respectively. For patients with diabetes, the targets for lower and upper fasting blood glucose levels ranged between 100-130 mg/dL and 128-150 mg/dL, respectively. Fasting blood glucose (95.6%) and HbA1c (78.6%) were the most commonly used clinical indicators to consider chemotherapy dose reduction, delay, or discontinuation due to hyperglycemia in patients receiving chemotherapy with curative intent. Among those receiving palliative intent chemotherapy, the preferred clinical parameters were random blood glucose (90.0%), patient-reported blood glucose readings (70.7%), continuous glucose monitoring readings (65.1%), and patient-reported symptoms of hyperglycemia (65.1%). Three main themes emerged about oncologists’ approach to hyperglycemia management: 1) identification of high-risk patients; 2) need for early identification, screening, and diagnosis of hyperglycemia; and 3) multiple hyperglycemia management strategies. Conclusion Oncologists reported a wide variation of target blood glucose ranges considered appropriate in patients undergoing chemotherapy. Lack of clear guidance for hyperglycemia management during chemotherapy in the United States may be contributing to a lack of consistency in clinical practice.

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Cancer patients with undiagnosed and poorly managed diabetes mellitus.

Cited by 2 publications

References 0 publications

Dying, dignity and diabetes

Dying, dignity and diabetes

Optimal hyperglycemia thresholds in patients undergoing chemotherapy: a cross sectional study of oncologists’ practices

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