Salgado Teresa M, Birari Poorva B, Alshahawey Mona, Hickey Zacholski Erin, Mackler Emily, Buffington Tonya M, Musselman Kerri T, Irvin William J, Perkins Jennifer M, Le Trang N, Dixon Dave L, Farris Karen B, Sheppard Vanessa B, Jones Resa M
Department of Pharmacotherapy & Outcomes Science, School of Pharmacy and Massey Cancer Center, Virginia Commonwealth University, 410 N. 12Th Street PO Box 98053, Richmond, VA, 23298, USA.
Department of Pharmacotherapy & Outcomes Science, School of Pharmacy, Virginia Commonwealth University, 410 N. 12Th Street PO Box 98053, Richmond, VA, 23298, USA.
Support Care Cancer. 2024 Aug 1;32(8):563. doi: 10.1007/s00520-024-08756-0.
Neither the United States nor the European oncology guidelines include details for appropriate management of hyperglycemia in cancer patients. The aim was to identify fasting and random blood glucose thresholds, and hemoglobin A1c (HbA1c) targets used by oncologists in clinical practice when managing hyperglycemia in patients with cancer undergoing chemotherapy.
This national, cross sectional study utilized a questionnaire to collect oncologists' perceptions about optimal blood glucose thresholds and HbA1c targets in patients with cancer undergoing chemotherapy. Descriptive statistics were calculated to summarize glucose thresholds, HbA1c targets, and sample characteristics. Responses to an open-ended question about oncologists' approach to hyperglycemia management were analyzed via thematic analysis using an inductive approach.
Respondents (n = 229) were on average 52.1 years of age, 67.7% men, and 91.3% White. For patients without diabetes but experiencing hyperglycemia, oncologists targeted lower and upper fasting blood glucose levels between 75-121 mg/dL and 105-135 mg/dL, respectively. For patients with diabetes, the targets for lower and upper fasting blood glucose levels ranged between 100-130 mg/dL and 128-150 mg/dL, respectively. Fasting blood glucose (95.6%) and HbA1c (78.6%) were the most commonly used clinical indicators to consider chemotherapy dose reduction, delay, or discontinuation due to hyperglycemia in patients receiving chemotherapy with curative intent. Among those receiving palliative intent chemotherapy, the preferred clinical parameters were random blood glucose (90.0%), patient-reported blood glucose readings (70.7%), continuous glucose monitoring readings (65.1%), and patient-reported symptoms of hyperglycemia (65.1%). Three main themes emerged about oncologists' approach to hyperglycemia management: 1) identification of high-risk patients; 2) need for early identification, screening, and diagnosis of hyperglycemia; and 3) multiple hyperglycemia management strategies.
Oncologists reported a wide variation of target blood glucose ranges considered appropriate in patients undergoing chemotherapy. Lack of clear guidance for hyperglycemia management during chemotherapy in the United States may be contributing to a lack of consistency in clinical practice.
美国和欧洲的肿瘤学指南均未包含癌症患者高血糖症恰当管理的详细内容。本研究旨在确定肿瘤学家在临床实践中管理接受化疗的癌症患者高血糖症时所采用的空腹血糖和随机血糖阈值以及糖化血红蛋白（HbA1c）目标。
这项全国性横断面研究采用问卷调查的方式，收集肿瘤学家对接受化疗的癌症患者最佳血糖阈值和HbA1c目标的看法。计算描述性统计数据，以总结血糖阈值、HbA1c目标和样本特征。通过归纳法进行主题分析，对关于肿瘤学家高血糖症管理方法的开放性问题的回答进行分析。
受访者（n = 229）平均年龄为52.1岁，男性占67.7%，白人占91.3%。对于无糖尿病但出现高血糖症的患者，肿瘤学家设定的空腹血糖下限和上限水平分别在75 - 121毫克/分升和105 - 135毫克/分升之间。对于糖尿病患者，空腹血糖下限和上限目标分别在100 - 130毫克/分升和128 - 150毫克/分升之间。空腹血糖（95.6%）和HbA1c（78.6%）是在考虑因高血糖症而减少、延迟或停止接受根治性化疗患者化疗剂量时最常用的临床指标。在接受姑息性化疗的患者中，首选的临床参数是随机血糖（90.0%）、患者报告的血糖读数（70.7%）、持续血糖监测读数（65.1%）以及患者报告的高血糖症状（65.1%）。关于肿瘤学家高血糖症管理方法出现了三个主要主题：1）识别高危患者；2）需要早期识别、筛查和诊断高血糖症；3）多种高血糖症管理策略。
肿瘤学家报告称，在接受化疗的患者中，所认为合适的目标血糖范围存在很大差异。美国在化疗期间缺乏高血糖症管理的明确指导，可能导致临床实践缺乏一致性。
