Impact of diabetes and hyperglycemia on health care utilization, infection risk, and survival in patients with cancer receiving glucocorticoids with chemotherapy

Zylla, Dylan; Gilmore, Grace; Eklund, Justin; Richter, Sara; Carlson, Anders

doi:10.1016/j.jdiacomp.2018.12.012

Cited by 23 publications

(26 citation statements)

References 21 publications

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“…In addition, the rate of hospitalization for infection during the 1 st year after initial chemotherapy was 37.0% in patients with diabetes and 29.2% in patients without diabetes, within 1 year after receiving their first chemotherapy, the admission rate to the hospital was about 8% higher for patients with diabetes ( P < 0.01). [ 27 ] Alkylating agent chemotherapy was the primary factor contributing to infectious disease in these patients. [ 32 ] The highest onset of risk factors was observed in diabetes with high blood pressure or tube feeding.…”

Section: Resultsmentioning

confidence: 99%

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Glycemic Excursion, Adverse Drug Reactions, and Self-Management in Diabetes Patients Undergoing Chemotherapy: A Literature Review

TERAO

Suzuki

2021

Asia-Pacific Journal of Oncology Nursing

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The purpose of this study was to identify the state of self-management in patients with diabetes who underwent chemotherapy, by referring to fluctuations in glycemic excursion and adverse drug reaction. We conducted a literature search in May 2021 using PubMed, CINAHL, and Ichushi-Web databases with “Cancer AND Diabetes AND Chemotherapy” as keywords. Based on our criteria, 25 articles were selected, and a review matrix sheet was created for the analysis of fluctuations in glycemic excursion and any adverse drug reaction to diabetes in patients undergoing chemotherapy. Substantial increases and unpredictable fluctuations in glycemic excursion were observed in these patients. In addition, an increase or change in the treatment dose was prevalent. Primarily, peripheral neuropathy and infection were reported as common adverse drug reactions. The risk of adverse drug reactions was especially high for patients with diabetes undergoing chemotherapy; furthermore, among this cohort, the detrimental effects were more likely to exacerbate into a severe condition that required special attention. Almost inevitably, the implementation rate of diabetes self-management programs decreased on the 8 th week after the commencement of chemotherapy. Considering the findings of large individual differences in fluctuation in this cohort, tailored assistance that is appropriate for each patient's chemotherapy regimen or blood glucose level is of paramount importance. Support of patient self-management to achieve stable blood glucose levels and thus prevent adverse drug reactions was a key component in the successful completion of chemotherapy and improved patient outcomes for this group of special needs patients.

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Section: Resultsmentioning

confidence: 99%

“…[ 32 36 ] None of the following were associated with the onset of infectious disease: HbA1c level, cancer stage, age, and gender. [ 27 ]…”

Section: Resultsmentioning

confidence: 99%

Glycemic Excursion, Adverse Drug Reactions, and Self-Management in Diabetes Patients Undergoing Chemotherapy: A Literature Review

TERAO

Suzuki

2021

Asia-Pacific Journal of Oncology Nursing

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“…However, a recent study which accounted for co-morbidities such as cardiovascular disease, found that cancer treatments were similar for patients with breast cancer regardless of diabetes status (75). Other possible factors relating to the increased cancer-specific mortality in individuals with diabetes, include presenting with advanced stage cancers at diagnosis (76), a higher risk of chemotherapy-related toxicity (77), as well as patient fragility resulting from chronic diabetes-associated complications (78).…”

Section: Type 2 Diabetes and Hyperglycemiamentioning

confidence: 99%

Obesity, Type 2 Diabetes, and Cancer Risk

2021

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Obesity and type 2 diabetes have both been associated with increased cancer risk and are becoming increasingly prevalent. Metabolic abnormalities such as insulin resistance and dyslipidemia are associated with both obesity and type 2 diabetes and have been implicated in the obesity-cancer relationship. Multiple mechanisms have been proposed to link obesity and diabetes with cancer progression, including an increase in insulin/IGF-1 signaling, lipid and glucose uptake and metabolism, alterations in the profile of cytokines, chemokines, and adipokines, as well as changes in the adipose tissue directly adjacent to the cancer sites. This review aims to summarize and provide an update on the epidemiological and mechanistic evidence linking obesity and type 2 diabetes with cancer, focusing on the roles of insulin, lipids, and adipose tissue.

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“…Supraphysiologic glucocorticoid use is known to raise glucose levels, particularly at the high doses that are required for therapeutic advantages. Glucocorticoid-induced hyperglycemia (GIH) is a well-known complication of their use in individuals with known diabetes (T1DM and T2DM) as well as those who were previously euglycemic[ 4 , 86 ]. Hyperglycemia is commonly reported in patients undergoing cancer therapy that includes glucocorticoids, however its true incidence is hard to define due to the variability in chemotherapy combinations, durations, and cycles.…”

Section: Glucocorticoidsmentioning

confidence: 99%

“…The degree of glucose elevations range widely and are most frequently modest (< 14 mmol/L)[ 92 ], nonetheless severe hyperglycemia (> 28 mmol/L) and DKA have also been reported[ 11 , 93 ], with rare reports of hyperglycemic hyperosmolar syndrome as well[ 94 ]. Other AE associated with GIH range from mild to serious, such as increased infections and lengthened of hospital stays[ 11 , 16 , 86 , 95 - 98 ]. The acute hyperglycemia associated with glucocorticoids will typically resolve upon discontinuation[ 4 , 99 , 100 ].…”

Section: Glucocorticoidsmentioning

confidence: 99%

Current cancer therapies and their influence on glucose control

Yim¹,

Mansell²,

Hussein³

et al. 2021

WJD

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This review focuses on the development of hyperglycemia arising from widely used cancer therapies spanning four drug classes. These groups of medications were selected due to their significant association with new onset hyperglycemia, or of potentially severe clinical consequences when present. These classes include glucocorticoids that are frequently used in addition to chemotherapy treatments, and the antimetabolite class of 5-fluorouracil-related drugs. Both of these classes have been in use in cancer therapy since the 1950s. Also considered are the phosphatidyl inositol-3-kinase (PI3K)/AKT/mammalian target of rapamycin (mTOR)-inhibitors that provide cancer response advantages by disrupting cell growth, proliferation and survival signaling pathways, and have been in clinical use as early as 2007. The final class to be reviewed are the monoclonal antibodies selected to function as immune checkpoint inhibitors (ICIs). These were first used in 2011 for advanced melanoma and are rapidly becoming widely utilized in many solid tumors. For each drug class, the literature has been reviewed to answer relevant questions about these medications related specifically to the characteristics of the hyperglycemia that develops with use. The incidence of new glucose elevations in euglycemic individuals, as well as glycemic changes in those with established diabetes has been considered, as has the expected onset of hyperglycemia from their first use. This comparison emphasizes that some classes exhibit very immediate impacts on glucose levels, whereas other classes can have lengthy delays of up to 1 year. A comparison of the spectrum of severity of hyperglycemic consequences stresses that the appearance of diabetic ketoacidosis is rare for all classes except for the ICIs. There are distinct differences in the reversibility of glucose elevations after treatment is stopped, as the mTOR inhibitors and ICI classes have persistent hyperglycemia long term. These four highlighted drug categories differ in their underlying mechanisms driving hyperglycemia, with clinical presentations ranging from potent yet transient insulin resistant states [type 2 diabetes mellitus (T2DM) -like] to rare permanent insulin-deficient causes of hyperglycemia. Knowledge of the relative incidence of new onset hyperglycemia and the underlying causes are critical to appreciate how and when to best screen and treat patients taking any of these cancer drug therapies.

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Impact of diabetes and hyperglycemia on health care utilization, infection risk, and survival in patients with cancer receiving glucocorticoids with chemotherapy

Cited by 23 publications

References 21 publications

Glycemic Excursion, Adverse Drug Reactions, and Self-Management in Diabetes Patients Undergoing Chemotherapy: A Literature Review

Glycemic Excursion, Adverse Drug Reactions, and Self-Management in Diabetes Patients Undergoing Chemotherapy: A Literature Review

Obesity, Type 2 Diabetes, and Cancer Risk

Current cancer therapies and their influence on glucose control

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