Hyperglycemia in Patients with Hematologic Malignancies

Abstract

Patients with hematologic malignancies are at high risk for hyperglycemia due to factors such as frequent exposure to glucocorticoids, immunosuppressants, total parenteral nutrition, and medical stress. Hyperglycemia in these patients has been associated with poor outcomes including increased risk of infection, organ dysfunction, durability of remission, graft-versus-host disease, and mortality. However, the appropriate glucose targets are not well established, and there are few prospective data assessing whether glucose control improves outcomes. HbA1c should be interpreted with caution in patients with hematologic malignancies, due to inaccuracies imposed by disordered hematopoiesis and frequent transfusions, and short-term perturbations imposed by acute illness or medications. Management of diabetes or glucocorticoid-induced hyperglycemia in the hospital generally requires insulin therapy, which is tailored based upon nutritional needs, baseline glucose control, and concomitant factors such as type and dose of glucocorticoid administration. Close follow-up and adjustment of therapy, ideally with the assistance of patient self-titration algorithms, is required after discharge. Patients are at increased long-term risk for developing diabetes and therefore should undergo regular screening.

Endocrine and Metabolic Disorders After Hematopoietic Stem Cell Transplantation Annalisa Paviglianiti Metabolic Diseases in Hematology

“…Hyperglycemia is a frequent metabolic alteration in patients with hematological diseases [4]. Glucocorticoids induce hyperglycemia by increasing insulin resistance through post-receptor insulin signaling defects [5].…”

How do I manage hyperglycemia/post-transplant diabetes mellitus after allogeneic HSCT

“…33 Another option to monitor glycemic control is measurement of glycoalbumin or fructosamine levels. 34 Because of rapid turnover of serum albumins compared with hemoglobin, the fructosamine and glycoalbumin levels reflect glucose control over a short period of 2-3 weeks. In addition, allo-HSCT recipients should be regularly screened for other cardiovascular risk factors that are commonly associated with diabetes.…”

Zaburzenia metaboliczne i wodno-elektrolitowe u pacjentów z hematologicznymi chorobami nowotworowymi

“…Hiperglikemia pogarsza wyniki leczenia u pacjentów z chorobami onkohematologicznymi, nasilając inne zaburzenia metaboliczne (np. kwasicy), zwiększając ryzyko infekcji, niewydolności narządowych, toksyczności chemioterapii i ogólnie, zwiększając śmiertelność [2,67].…”

“…W przypadkach ostrej ciężkiej hiperglikemii należy stosować intensywną insulinoterapię, płyny dożylnie oraz wyrównywać zaburzenia elektrolitowe i kwasowo-zasadowe. W przewlekłej hiperglikemii -cukrzycy typu 2 stosuje się insulinę lub doustne leki hipoglikemizujące [67].…”