Date of Award
Doctor of Philosophy in Nursing (PhD)
Geri Wood, PhD
Terri Armstrong, PhD
Victor Lavis, MD
Hyperglycemia as a result of glucocorticoid administration (steroid-induced hyperglycemia [SIH]) occurs in 32-37% of adult patients with cancer both with and without previous history of diabetes. Patients diagnosed with mantle cell lymphoma (MCL) are often treated with chemotherapy regimens that include high dose steroids as first line therapy. Little is known about the prevalence of steroid-induced hyperglycemia in patients with MCL receiving high dose steroids. Moreover it is not known if how the resulting hyperglycemia is managed impacts time to relapse or death.
The primary aim of this study was to determine the prevalence of SIH in MCL patients with and without pre-existing diabetes receiving high dose steroids. The secondary aims were to: (1) determine the persistence of resulting hyperglycemia, (2) determine how hyperglycemia was managed, (3) and to examine the association between hyperglycemia and time to relapse or time to death.
A retrospective chart review was conducted, of electronic health records of patients over the age of 18, with diagnosis of MCL, receiving treatment at UT MD Anderson Cancer Center between 1/1/2000 through 12/31/2010.
SIH occurred in 127 patients (70% of the cohort), with 57% of SIH being associated with the first cycle of chemotherapy (during or following the 1st course of steroids). Higher mean baseline blood glucose (p=0.0290) and history of diabetes (p=0.0013) were the only factors found to be related to the development of SIH. Hyperglycemia was found to be persistent at 3-6 months in 3 (7%) of the 46 patients with history of diabetes and 4(5%) of the 81 patients with no history. There was no significant difference in SIH management between those with and without persistent hyperglycemia (p=0.8839) and management of SIH did not show a significant impact on time to relapse or death. Although occurrence of SIH did not have a statistically significant impact on time to relapse(p=0.0763) those who experienced SIH had a median time to relapse of 4.58 years and those without SIH had yet to reach median time to relapse.
Steroid-Induced hyperglycemia is prevalent in patients receiving high dose steroids with and without history of diabetes and glucose elevations persistent in 5-7% of patients after steroids have been discontinued. Each 10mg/dL increase in baseline blood glucose increases the odds of patients developing SIH. However, this retrospective study does not show that SIH has a significant impact on time to relapse or time to death. Prospective studies designed to examine the relationship between the degree of hyperglycemia, the number of hyperglycemic events and time to relapse and death are needed.
Brady, Veronica, "Prevalence of Steroid-Induced Hyperglycemia in Patients with Mantle Cell Lymphoma Receiving High Dose Steroids" (2015). UT SON Dissertations (Open Access). 18.
Steroids, hyperglycemia, cancer