Marieke Tienstra MSc , Janneke W. de Boer MD , Jaap A. van Doesum MD , Kylie Keijzer MSc , Linde M. Morsink MD , Carin L.E. Hazenberg MD , Emanuele Ammatuna MD, PhD , Gerwin A. Huls MD, PhD , Pratik Choudhary MD, PhD , Rijk O.B. Gans MD, PhD , Valerie R. Wiersma PhD , Tom van Meerten MD, PhD , Peter R. van Dijk MD, PhD
{"title":"High Frequency of Severe Hyperglycemia Observed During Intensive Hematologic Care: A Prospective Study Using Continuous Glucose Monitoring","authors":"Marieke Tienstra MSc , Janneke W. de Boer MD , Jaap A. van Doesum MD , Kylie Keijzer MSc , Linde M. Morsink MD , Carin L.E. Hazenberg MD , Emanuele Ammatuna MD, PhD , Gerwin A. Huls MD, PhD , Pratik Choudhary MD, PhD , Rijk O.B. Gans MD, PhD , Valerie R. Wiersma PhD , Tom van Meerten MD, PhD , Peter R. van Dijk MD, PhD","doi":"10.1016/j.eprac.2024.09.013","DOIUrl":null,"url":null,"abstract":"<div><h3>Objective</h3><div>During intensive hematologic care, patients are exposed to high-dose chemotherapy, corticosteroids, immunosuppressants, and total parenteral nutrition. Combined with physiologic stress and increased release of cytokines and hormones, this can lead to dysglycemia, which is associated with adverse clinical outcomes. This prospective study aimed to investigate continuous glucose monitoring (CGM) to identify dysglycemia during intensive hematologic care.</div></div><div><h3>Methods</h3><div>Patients receiving chimeric antigen receptor T-cell therapy or allogeneic or autologous stem cell transplantation were eligible. Throughout the study, glucose levels were concurrently monitored using CGM and point-of-care (POC) glucose measurements in 60 patients (71% male, median age of 64 [interquartile range, 58-68] years, and 10% with diabetes).</div></div><div><h3>Results</h3><div>Hyperglycemia (glucose level, >10 mmol/L) was prevalent in 93% of patients, of whom 90% had no history of diabetes. Severe hyperglycemia (glucose level, >13.1 mmol/L) was present in 38%. Additionally, hyperglycemia was associated with prolonged hospitalization in patients undergoing chimeric antigen receptor T-cell treatment (β, 0.19; 95% CI, 0.04-0.35) and autologous stem cell transplantation (β, 0.16; 95% CI, 0.01-0.32). CGM outperformed POC in detecting hyperglycemia (>10 mmol/L: 1060 vs 124, detected 2.8 [interquartile range, 0.7-4.0]) hours earlier. The mean absolute relative difference between CGM and POC was 21.5%, with 99.8% of measurements in the clinical acceptable zone A + B of the Clarke error grid.</div></div><div><h3>Conclusion</h3><div>These findings emphasize the potential and importance of glucose monitoring with CGM for improved and earlier detection of hyperglycemia, in this patient population, which seems feasible. Our results suggest a need for further studies into CGM as method to optimize glucose levels, which could improve outcomes in patients receiving intensive hematologic care.</div></div>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":"30 12","pages":"Pages 1141-1148"},"PeriodicalIF":3.7000,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Endocrine Practice","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1530891X24006797","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"ENDOCRINOLOGY & METABOLISM","Score":null,"Total":0}
引用次数: 0
Abstract
Objective
During intensive hematologic care, patients are exposed to high-dose chemotherapy, corticosteroids, immunosuppressants, and total parenteral nutrition. Combined with physiologic stress and increased release of cytokines and hormones, this can lead to dysglycemia, which is associated with adverse clinical outcomes. This prospective study aimed to investigate continuous glucose monitoring (CGM) to identify dysglycemia during intensive hematologic care.
Methods
Patients receiving chimeric antigen receptor T-cell therapy or allogeneic or autologous stem cell transplantation were eligible. Throughout the study, glucose levels were concurrently monitored using CGM and point-of-care (POC) glucose measurements in 60 patients (71% male, median age of 64 [interquartile range, 58-68] years, and 10% with diabetes).
Results
Hyperglycemia (glucose level, >10 mmol/L) was prevalent in 93% of patients, of whom 90% had no history of diabetes. Severe hyperglycemia (glucose level, >13.1 mmol/L) was present in 38%. Additionally, hyperglycemia was associated with prolonged hospitalization in patients undergoing chimeric antigen receptor T-cell treatment (β, 0.19; 95% CI, 0.04-0.35) and autologous stem cell transplantation (β, 0.16; 95% CI, 0.01-0.32). CGM outperformed POC in detecting hyperglycemia (>10 mmol/L: 1060 vs 124, detected 2.8 [interquartile range, 0.7-4.0]) hours earlier. The mean absolute relative difference between CGM and POC was 21.5%, with 99.8% of measurements in the clinical acceptable zone A + B of the Clarke error grid.
Conclusion
These findings emphasize the potential and importance of glucose monitoring with CGM for improved and earlier detection of hyperglycemia, in this patient population, which seems feasible. Our results suggest a need for further studies into CGM as method to optimize glucose levels, which could improve outcomes in patients receiving intensive hematologic care.
期刊介绍:
Endocrine Practice (ISSN: 1530-891X), a peer-reviewed journal published twelve times a year, is the official journal of the American Association of Clinical Endocrinologists (AACE). The primary mission of Endocrine Practice is to enhance the health care of patients with endocrine diseases through continuing education of practicing endocrinologists.