Incident hyperglycemia, parenteral nutrition administration and adverse outcomes in patients with myeloma admitted for initial auto-SCT

Measurement of Hyperglycemia and Impact on Health Outcomes in People With Cancer: Challenges and Opportunities

PROBLEM IDENTIFICATION

Poor health outcomes have been associated with hyperglycemia in patients with and without diabetes. However, the impact of hyperglycemia on the health-related outcomes of patients with cancer has shown conflicting results. The purpose of this review was to explore definitions and measurement issues related to the assessment of hyperglycemia and the subsequent impact on the findings of health-related outcomes in adults with cancer.
.

LITERATURE SEARCH

Four electronic databases were searched.

DATA EVALUATION

A total of 30 articles were reviewed. Quantitative articles were synthesized using integrative review strategies. 
.

SYNTHESIS

Three key gaps were identified in the literature.

CONCLUSIONS

This review highlights the inconsistencies in measuring or assessing hyperglycemia and the lack of standardized guidelines in treating hyperglycemia. Failure to have a standard approach to the measurement and management of hyperglycemia impedes the ability of healthcare providers to determine the significance of its impact on health outcomes. Further research is needed to establish appropriate measurement guidelines to address hyperglycemia in people with cancer.
.

IMPLICATIONS FOR PRACTICE

Evidence-based measurement and treatment guidelines are needed to inform and assist healthcare providers with clinical decision making for people with cancer who experience hyperglycemia.

PGC-1α is responsible for survival of multiple myeloma cells under hyperglycemia and chemotherapy

The association between hyperglycemia and outcomes during chemotherapy has been reported in several tumors, including multiple myeloma (MM). However, the underlying mechanism of how hyperglycemia affects the survival of MM cells during chemotherapy remain to be elucidated. MM cells were cultured in 10 mM glucose with or without chemotherapeutic agents. Following treatment of MM cells with dexamethasone or bortezomib, an MTT assay was used to evaluate the toxicity of dexamethasone or bortezomib on cell proliferation, and changes of reactive oxygen species (ROS) level were detected by flow cytometry (FCM) analysis. Small interference RNA (siRNA) was applied to inhibit the expression of peroxisome proliferator-activated receptor γ coactivator-1α (PGC-1α). Expressions of PGC-1α and antioxidant factors such as superoxide dismutase 2 (SOD‑2), glutathione peroxidase 1 (GPX-1), and catalase (CAT) were measured by RT-PCR prior to and following treatment. The results showed that the level of PGC-1α in MM cells cultured in high-glucose medium was upregulated prior to and following treatment of chemotherapeutic agents, and these cells showed less fold-change of ROS after insult of drugs, when compared to the control. Genes encoding antioxidant factors such as SOD-2 and CAT were also upregulated. Inhibition of PGC-1α enhanced the toxicity of antitumor agents, associated with reduced expression of antioxidant factors, and elevated level of ROS. The present findings suggested that hyperglycemia may influence the anticancer effect of chemotherapeutic agents in MM by upregulating the expression of PGC-1α and associated antioxidant factors. Inhibition of PGC-1α or control of hyperglycemia may be beneficial in improving the efficacy of chemotherapy in MM patients with diabetes.

Prevalence and impact of hyperglycemia on hospitalized leukemia patients

PURPOSE

Hyperglycemia is a common phenomenon in hospitalized patients and has been associated with poor clinical outcomes. Hyperglycemia was defined as a fasting blood glucose ≥126 mg/dL. In cancer patients' hyperglycemia has been associated with impacting diagnostic imaging studies; facilitating the development of and progression of cancers, and influencing response to treatment. Little is known about the impact of hyperglycemia on clinical outcomes such as: neutropenia, infection and hospital length of stay in hospitalized patients with leukemia. The purpose of this study was to examine the impact of hyperglycemia on the following clinical outcomes: neutropenia, infection and hospital length of stay.

METHODS

This retrospective study examined the prevalence and impact of hyperglycemia on clinical outcomes in this vulnerable population.

RESULTS

In this sample of 42 hospitalized patients with leukemia, 60% had at least one incidence of hyperglycemia. Patients with hyperglycemia were 1.6 times more likely (p < 0.01) to experience neutropenia than those without hyperglycemia. However, no difference was noted between those with and without hyperglycemia and risk for infection (p = 0.23). Hospital length of stay was significantly longer in patients with hyperglycemia (2 days versus 15 days; p < 0.001) than those without hyperglycemia.

CONCLUSIONS

The findings from this study provide preliminary evidence demonstrating hyperglycemia in the leukemia patient is common and has detrimental effects on clinical outcomes. Understanding the impact of hyperglycemia will inform interventions to mitigate its consequences and improve quality of life for patients with leukemia.