New guidance has been published for the oncology and diabetes multidisciplinary team on the management of glycaemic control in people with cancer.

As well as guidelines on identifying individuals without a known diagnosis of diabetes who are at risk of developing hyperglycaemia and new onset diabetes, the report, produced on behalf of the UK Chemotherapy Board and JBDS, provides the oncology/haemato-oncology multidisciplinary team with advice on managing people with diabetes commencing anti-cancer/glucocorticoid therapy.

“Individuals with cancer are at increased risk of developing new onset diabetes mellitus and hyperglycaemia, and an estimated 20 per cent of people with cancer already have an underlying diagnosis of diabetes mellitus,” the authors say.

“People with both cancer and diabetes may have an increased risk of toxicities, hospital admissions and morbidity, with hyperglycaemia potentially attenuating the efficacy of chemotherapy often secondary to dose reductions and early cessation. Numerous studies have demonstrated that hyperglycaemia is prognostic of worse overall survival and risk of cancer recurrence.”

The guidance includes dietetic recommendations and the following pathways:

• Commencing anti-cancer therapy/glucocorticoids in cancer patients without a previous diagnosis of diabetes.
• Commencing immune checkpoint inhibitors in cancer patients without a previous diagnosis of diabetes.
• Commencing SACT/glucocorticoid therapy in cancer patients with type 2 diabetes on oral glucose lowering agents.
• Commencing SACT/glucocorticoid therapy in cancer patients with diabetes treated with insulin.

View the updated guidelines here and the oncology guideline pathways here.