Diurnal profile of interstitial glucose following dexamethasone prophylaxis for chemotherapy treatment of gynaecological cancer

• Published in: Diabetic medicine 2018-11, Vol.35 (11), p.1508-1514
• Main Authors: Lyall, M. J., Thethy, I., Steven, L., MacKean, M., Nussey, F., Sakala, M., Rye, T., Strachan, M. W. J., Dover, A. R.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Blood Glucose - analysis; Blood Glucose - drug effects; Blood Glucose - metabolism; Blood Glucose Self-Monitoring; Cancer; Carboplatin; Chemoprevention - methods; Chemotherapy; Circadian Rhythm - drug effects; Circadian Rhythm - physiology; Cohort Studies; Data processing; Dexamethasone; Dexamethasone - administration & dosage; Dexamethasone - adverse effects; Diabetes; Diabetes mellitus; Diurnal; Extracellular Fluid - chemistry; Extracellular Fluid - metabolism; Female; Genital Neoplasms, Female - drug therapy; Genital Neoplasms, Female - metabolism; Glucocorticoids; Glucose; Glucose - analysis; Glucose - metabolism; Glucose monitoring; Gynecological cancer; Gynecology; Humans; Hyperglycemia; Hyperglycemia - chemically induced; Hyperglycemia - diagnosis; Hyperglycemia - metabolism; Middle Aged; Monitoring, Physiologic - methods; Paclitaxel; Prophylaxis; Risk factors; Skin - chemistry; Skin - metabolism; Steroids
• ISSN: 0742-3071; 1464-5491; 1464-5491
• DOI: 10.1111/dme.13770

Aims Hyperglycaemia, a side‐effect of acute glucocorticoid exposure, is associated with poor outcome in those undergoing chemotherapy. The incidence, risk factors and diurnal profile of glucocorticoid‐induced glucose dysregulation in the context of chemotherapy treatment remain incompletely understood. Methods Blinded continuous interstitial glucose monitoring was performed on 16 women without diabetes for 24 h prior to and 5 days following carboplatin/paclitaxel chemotherapy combined with dexamethasone treatment for gynaecological cancer. At the end of the treatment period, glucose data were analysed and integrated with baseline metabolic and anthropomorphic variables. Results 15/16 (94%) women exhibited elevated glucose levels (> 11.1 mmol/l). Peak glucose levels were highest on the day of treatment (median 14.45 mmol/l, range 10.2–22.2 mmol/l) and total time spent with an elevated interstitial glucose level was highly variable (median 3.6 h, range 0.0–55.1 h). Peak interstitial glucose levels occurred predominantly, but not exclusively, in the afternoon (13.00–15.00) and evening (19.00–22.00); however elevated levels were noted throughout the 24‐h period. Baseline HbA1c was independently associated with severity and duration of elevated glucose levels in a regression adjusted for baseline BMI. Conclusions These data report for the first time that high glucose levels are encountered by nearly all women following this regimen, the severity and duration of which are independently associated with HbA1c. Further work is required to determine if controlling glucose levels during treatment influences outcome. What's new? Hyperglycaemia during chemotherapy treatment is associated with negative health outcomes. The incidence, severity and diurnal profile of glucose dysregulation during chemotherapy are unclear, limiting development of screening and treatment protocols. Utilizing continuous glucose monitoring, these data demonstrate that elevated glucose levels affect nearly all women treated with a standard carboplatin/paclitaxel/dexamethasone chemotherapeutic regimen for gynaecological cancer. The diurnal profile is described with peak glucose windows for opportunistic monitoring. HbA1c was independently associated with the severity and duration of glucose excursions.