Patterns of Glucose Fluctuation are Challenging in Patients Treated for Non-Hodgkin’s Lymphoma
Received 13 January 2020
Accepted for publication 25 March 2020
Published 15 April 2020 Volume 2020:13 Pages 131—140
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Dr Scott Fraser
Andreja Marić,1 Tanja Miličević,2 Jelena Vučak Lončar,3 Davor Galušić,2 Maja Radman2
1Department of Internal Medicine, County Hospital Čakovec, Čakovec 40000, Croatia; 2Department of Internal Medicine, University Hospital Center Split, Split 21000, Croatia; 3Department of Internal Medicine, County Hospital Zadar, Zadar 23000, Croatia
Correspondence: Tanja Miličević Email firstname.lastname@example.org
Purpose: This cohort study aimed to determine patterns of glycemic fluctuation and changes in metabolic parameters during and after corticosteroid administration in newly diagnosed diffuse large B-cell lymphoma (DLBCL) patients treated with R-CHOP chemotherapy.
Patients and Methods: The study was performed in 20 patients of whom 11 had diabetes and 9 were nondiabetics. Anthropometric parameters were collected, and blood samples were taken four times during the study to analyze metabolic parameters. Capillary glucose was measured seven times a day (fasting, before mean meals, postprandial, and before bedtime) to evaluate the glycemic profile.
Results: In all 20 patients, acute glucocorticoid administration resulted in the elevation of average glucose levels, dominantly postprandial in the afternoon which correlates with corticosteroid peak action. In 7 out of 11 diabetics, prandial insulin was started during corticosteroid administration and discontinued afterward. Although none of our nondiabetic patients met diabetes criteria, evident is the elevation in average glycemia levels six weeks after corticosteroid administration. Potentially, even transient corticosteroid administration reduces insulin sensitivity and contributes to later glycemic disturbances. HbA1c levels were higher at the end of the study while fructosamine levels were higher during the study.
Conclusion: Patients and health-care professionals need to be aware of corticosteroid-induced hyperglycemia. We recommend identifying risk factors, measuring glycemia before, during, and after corticosteroid administration, and starting the adequate therapy as soon as possible.
Keywords: hyperglycemia, glucocorticoids, lymphoma, glucose variability
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