Background
Chemotherapy regimens can have a significant impact on blood glucose levels (BGL’s) in patients with or without diabetes. Identifying and managing these patients, who are often treated in day chemotherapy wards is a challenge. Historically, BGL’s were not monitored in the Day Oncology Centre. The Western and Central Melbourne Integrated Cancer Services’ (WCMICS) Diabetes and Cancer project developed guidelines for detecting and managing diabetes during chemotherapy treatment. We report their implementation in the Day Oncology Centre.
Methods
Extensive education and support was provided to the day oncology staff and a ‘Diabetes and Oncology’ information sheet was developed for patients attending pre-chemotherapy education. New nursing care plans mandated a finger prick or venous BGL and HbA1c on all patients. Loan blood glucose meters were available to patients without diabetes. Staff were to refer patients commencing on steroids or with BGL’s 12mmol/l to the Diabetes Team.
Findings
Fifty three patients were identified with or at risk of developing diabetes/ unstable BGLs as a result of their chemotherapy regimen. 27 (51%) patients were identified through the pre-chemo assessment and 9 were referred by concerned staff. 39 (73%) of the 53 patients identified received steroids as part of their regimen. 34 (64%) had their BGL checked during treatment and 28 (53%) had a HbA1c. Of the 34 patients, 12 (35%) had levels below 4mmol/l or above 12mmol/l; 8 were referred to Diabetes Education and Endocrinology. The day oncology staff engaged and worked extremely well with the Diabetes Team.
Implications
Through increased education, support and awareness about diabetes, we changed standard practice to include random BGL and HbA1c testing. We increased vigilance and referral of cancer patients with unstable BGL’s in the Day Oncology Centre. We expect this initiative will improve outcomes for patients by reducing risk of adverse glycaemic outcomes.