Managing people with diabetes during the cancer palliation in the era of simultaneous care

Glycemic control and cancer outcomes in oncologic patients with diabetes: an Italian Association of Medical Oncology (AIOM), Italian Association of Medical Diabetologists (AMD), Italian Society of Diabetology (SID), Italian Society of Endocrinology (SIE), Italian Society of Pharmacology (SIF) multidisciplinary critical view

BACKGROUND

 Increasing evidence suggests that diabetes increases the risk of developing different types of cancer. Hyperinsulinemia, hyperglycemia and chronic inflammation, characteristic of diabetes, could represent possible mechanisms involved in cancer development in diabetic patients. At the same time, cancer increases the risk of developing new-onset diabetes, mainly caused by the use of specific anticancer therapies. Of note, diabetes has been associated with a ∼10% increase in mortality for all cancers in comparison with subjects who did not have diabetes. Diabetes is associated with a worse prognosis in patients with cancer, and more recent findings suggest a key role for poor glycemic control in this regard. Nevertheless, the association between glycemic control and cancer outcomes in oncologic patients with diabetes remains unsettled and poorly debated.

PURPOSE

 The current review seeks to summarize the available evidence on the effect of glycemic control on cancer outcomes, as well as on the possibility that timely treatment of hyperglycemia and improved glycemic control in patients with cancer and diabetes may favorably affect cancer outcomes.

Hospitalization as an Opportunity to Optimize Glycemic Control in Oncology Patients

PURPOSE OF REVIEW

Many patients experience hyperglycemia during cancer treatment, either as a new-onset condition or as an exacerbation of existing diabetes. This can impact treatment and outcomes, increasing the risk of complications and worsening health-related quality of life (HRQoL). These issues may be particularly significant when patients are hospitalized and/or acutely ill. The purpose of this review is to identify common barriers and strategies specific to the inpatient setting to improve glycemic control and minimize complications both while patients are hospitalized and after discharge.

RECENT FINDINGS

Hyperglycemia in patients who are hospitalized during cancer treatment is common, but there is a lack of consensus on goals and approaches to glycemic management in this setting. Hyperglycemia related to oncology treatment can have unusual causes and challenges in management. Organizational guidelines can help standardize treatment and guide providers in managing hyperglycemia in oncology patients during hospitalization and upon discharge. Hospitalization is a critical period that provides an opportunity to reassess and modify management plans, coordinate follow-up care, and, crucially, educate and empower patients to successfully manage their blood glucose levels once they are discharged. Emerging technology such as patient portals can facilitate hyperglycemia management after discharge. This review discusses evidences and strategies to utilize the period of hospitalization to develop and implement an individualized plan of care for patients with concurrent hyperglycemia and cancer.

Diabetes-related symptoms, acute complications and management of diabetes mellitus of patients who are receiving palliative care: a protocol for a systematic review

INTRODUCTION

Worldwide, an estimated 40 million people are in need of palliative care each year, but only 14% receive it. The incidence of diabetes mellitus (DM) in patients receiving palliative care is higher than in the general population. This association is intended to grow as a result of the rising burden of DM worldwide, ageing populations and the improved overall survival time of several diseases over the last few decades. Recommendations for DM management in the context of palliative care are mainly based on expert opinion as there is a lack of suitable evidence base and randomised clinical trials in palliative care are scarce. The aim of our systematic review is to identify the best DM management practices in order to reduce important DM-related symptoms and acute complications in patients receiving palliative care.

METHODS AND ANALYSIS

The authors will study the DM treatment and management literature, surveying the different approaches employed to treat adult palliative patients. Core health bibliographic databases will be searched from January 1990 to May 2019. Data sources will include Ovid MEDLINE, Embase, PubMed, Web of Sciences, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Scopus, Cumulative Index to Nursing and Allied Health Literature and grey literature. Details regarding diet, oral and injectable glucose-lowering medicines, insulin regimens and blood glucose monitoring strategies will be evaluated. We defined the primary outcomes to compare between DM management approaches as the presence of symptoms (polyuria, polydipsia and polyphagia) and acute complications of DM (hypoglycaemia, hyperglycaemic hyperosmolar state and diabetic ketoacidosis), and secondary outcomes as hospital admissions and deaths due to DM-related complications, health-related quality of life and glycaemic control.

ETHICS AND DISSEMINATION

The systematic review methodology does not require ethics approval due to the nature of the study design. The results of the systematic review will be published in a peer-reviewed journal and will be publicly available.

PROSPERO REGISTRATION NUMBER

CRD42018115772.