Background: In patients with cancer, diabetes is prevalent and associated with poorer prognosis. Surgery, chemotherapy and steroids significantly impact glycaemic control. We undertook an audit in this group as baseline study to determine the benefit of future management initiatives.
Methods: All patient admissions coded with cancer and unstable diabetes from Oct 2014 to Oct 2015 were identified. Histories and pathology were reviewed. Hyperglycaemia was defined as preprandial blood glucose level (BGL)>8.0mmol/L, hypoglycaemia was defined as BGL<4.0mmol/L. The aim was to determine current management of unstable diabetes in cancer patients.
Results: There were 108 admissions identified, with 96 admissions available for review. Median age was 69yr (range 43-89); 53 (55%) were male. A majority of patients had type 2 diabetes (n=92) and were insulin-requiring (n=50). Solid organ malignancies were present in 68 (71%) patients and haematological malignancies in 28 (29%). Chemotherapy was required for 19 (20%) patients and surgery in 35 (36%). Notably, 16 (17%) patients received end-of-life care.
Glycaemic emergencies were the reason for admission in 3 cases (HHS, severe hyperglycaemia and hypoglycaemia). During admission, diabetes control issues were hyperglycaemia (n=64, 67%), hypoglycaemia (n=8, 8%) and both hyperglycaemia/hypoglycaemia (n=24, 25%). Significant factors in hyperglycaemia cases included steroid-use (n=42) and infection (n=27).
BGL were recorded in 92 (96%) patients; 55 (57%) had biochemical blood glucose measurements and 20 (20%) had HbA1c tested. Management was largely conducted by the parent unit, with endocrinology consultation in 21 (22%) and diabetes nurse educator involvement in 14 (15%) patients. Eighteen (19%) patients died during admission, no deaths were due to diabetes-related complications.
Conclusion: This audit characterises clinical features of patients with cancer and unstable diabetes. The development of a standardised approach to the management of diabetes in this population, taking into account overall prognosis, may reduce the incidence of glycaemic and other adverse events.