Background: Current literature suggests that the incidence of corticosteroid-induced hyperglycaemia amongst patients receiving corticosteroids with chemotherapy is around 2-12%, with the incidence being proportional to the dose & duration of steroids. Poor glycaemic control has been linked to poorer outcomes (increased risks of infections, prolonged hospital stay and mortality) in cancer patients. There is currently limited literature on the management of corticosteroid-induced hyperglycaemia in the outpatient cancer care setting.
Aim: To investigate the incidence of hyperglycaemia and hyperglycaemic emergencies amongst patients receiving corticosteroids with chemotherapy at the Illawarra Cancer Care Centre (ICCC).
Method: Identified 150 consecutive patients in the month of December 2020, receiving >4mg of dexamethasone (or equivalent) with chemotherapy cycle. Electronic records were reviewed for the following variables: age, gender, diabetes status, corticosteroid type and dose, frequency of BGL checks, highest BGL, HbA1c, contact with endocrine, hospital admission for hyperglycaemic emergency.
Results: Among the 150 patients, 104 (69.3%) have BGL checks performed during their chemotherapy cycles. Of 104 patients, 9 (8.7%) had episodes of hyperglycaemia as defined by BGL >11.0mmol. Patients generally had BGLs recorded on pre-chemotherapy blood tests, and not on the day of chemotherapy. Of the 9 patients, 1 patient required admission to hospital for management of their hyperglycaemia.
Conclusion: This audit provides an insight into the current practice at ICCC in regards to detection and management of corticosteroid-induced hyperglycaemia. Our incidence of hyperglycaemia mirrors that of current literature. Corticosteroid-induced hyperglycaemia may be missed given the timing of BGL checks on pre-chemotherapy blood tests. We have developed a corticosteroid-induced hyperglycaemia management flowsheet along with a patient information sheet for our cancer care centre, with the aim of increasing the detection of corticosteroid-induced hyperglycaemia and facilitating its subsequent management.