There are no published guidelines for diabetes (DM) screening or management in cancer patients. We developed consensus guidelines and report on the pilot at Day Centres at St Vincent’s (SVHM) and Royal Melbourne Hospital (RMH).
At SVHM medical staff were asked to use the guidelines and screen for DM during the patient’s appointment in the Cancer Day centre. Patients with elevated HbA1c were referred to Endocrinology or Diabetes Educators using the SVHM protocol.
At RMH patients were monitored for DM/unstable blood glucose levels (BGL’s) via finger prick or venous BGL and HbA1c at the Day Centre during pre-chemo education. Those with pre-existing or newly diagnosed DM, or who were commencing steroids were referred for diabetes education and dietitian review. BGL’s were monitored pre-meals and pre-bed (target BGL 5-15mmol/l). Patients with BGL’s <4mmol/l or ≥ 12mmol/l were referred to the Diabetes Team.
At SVHM 177 patients attended the Day Centre; 11% had pre-existing DM. 31% had HbA1c tested and 11% of these were diagnosed with HbA1c ≥6.5%. 80% received steroids during treatment. 52% had documented treatment changes compared to 21% pre pilot.
At RMH 53 patients were identified; 14 (26%) had pre-existing DM and 2 were referred with new DM. HbA1c was performed in 28; 4 had HbA1c’s 6.5-8.0% without pre-existing DM. 38 (73%) received steroids. 12 (23%) were identified with BGL’s outside the target range; 8 of these patients were referred to the Diabetes Team. All patients required higher insulin doses on days of chemotherapy/steroid treatment and all required frequent BGL and insulin dose review.
The guideline was beneficial in improving practices for identifying new and unstable DM, increasing HbA1c testing, increasing referral to appropriate services and commencement/ adjustment of diabetes medications and insulin.
Funding obtained from the Western and Central Melbourne Integrated Cancer Service