Evaluation of Blood Glucose Levels in Patients having Chemotherapy Treatment in Combination with Corticosteroids: A Prospective Cohort Study
This prospective cohort study of 148 patients undergoing chemotherapy with corticosteroids found that steroid-induced hyperglycemia is common, particularly in those with pre-existing diabetes, and that 12% of non-diabetic patients developed steroid-induced diabetes by week 12, highlighting the need for universal nurse-led blood glucose monitoring and management.
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When people undergo chemotherapy to treat cancer, doctors often give them powerful anti-inflammatory medicines called corticosteroids. These drugs are essential helpers; they calm the body's immune response and stop the severe nausea that often comes with chemotherapy. However, these same medicines have a side effect that can be difficult to manage: they cause blood sugar levels to rise. For some patients, this rise is temporary and harmless, but for others, it can lead to dangerously high blood sugar, a condition known as hyperglycemia. If left unchecked, high blood sugar can make patients feel exhausted, thirsty, and unwell, and it can even interfere with their cancer treatment. While doctors know this happens, they have not always had a clear picture of how often it occurs in real-world clinics, or whether it affects patients differently depending on their health history.
A team of researchers at a private hospital in Perth, Western Australia, set out to map this hidden landscape. They followed 148 adults who were starting chemotherapy combined with corticosteroids. The goal was simple but vital: to track blood sugar levels over time and see who developed high blood sugar, who developed it because of the treatment, and whether the patients could feel it coming. The researchers recruited patients who had just been diagnosed with various cancers, including breast, pancreatic, and colorectal cancer. Before the first dose of chemotherapy, the team checked each person's health history and measured their blood sugar and a long-term marker called HbA1c, which shows average blood sugar over the past few months. They then gave every participant a small device to measure their own blood sugar at home. The instructions were specific: check the blood sugar two hours after every meal on the day after treatment, and write down the highest number of the day. They also asked patients to note if they felt thirsty, needed to urinate often, felt tired, or had blurry vision. This process was repeated at six weeks and again at twelve weeks for those who were still undergoing treatment.
The results revealed that high blood sugar is a very common companion to cancer treatment. At the start of the study, nearly one-third of the patients already had diabetes. Among those who did not have diabetes before treatment, about one-third developed high blood sugar during the course of their chemotherapy. This condition, known as steroid-induced hyperglycemia, appeared in roughly 30 percent of patients at every stage of the study, whether it was the first week or the twelfth. The researchers found that patients who already had diabetes were much more likely to experience these spikes in blood sugar than those who did not. However, the study also uncovered a surprising fact: the usual warning signs that people associate with high blood sugar are not reliable in this setting. Many patients reported feeling fine even when their blood sugar was dangerously high, while others reported feeling sick when their levels were normal. The most common symptom reported was simply tiredness, which is also a common side effect of chemotherapy itself, making it hard to tell what was causing the fatigue.
Perhaps the most significant finding concerns the long-term impact of these treatments. The researchers discovered that for some patients, the high blood sugar did not go away once the treatment ended. Twelve percent of the patients who started the study without diabetes were found to have developed a new diagnosis of diabetes at 12 weeks after commencing treatment, while they were still on therapy. This suggests that for a significant number of people, the treatment can trigger a permanent change in how their bodies manage sugar. The study also looked at whether factors like age, body weight, or the specific amount of steroid given could predict who would get high blood sugar. Surprisingly, none of these factors made a clear difference. Older patients or those with higher body weight were not necessarily more likely to develop the condition, and the size of the steroid dose did not seem to correlate with the severity of the blood sugar spikes. This challenges the idea that doctors can easily predict who will be at risk based on standard health profiles.
The study concludes that relying on patients to report symptoms is not enough to catch this problem. Because so many people feel no symptoms despite having high blood sugar, the researchers argue that active monitoring is essential. They suggest that nurses should take the lead in checking blood sugar levels for all patients receiving this combination of treatments, regardless of whether they have a history of diabetes. By catching high blood sugar early and managing it properly, medical teams can prevent it from becoming a permanent condition and ensure that patients feel better while they fight their cancer. The work highlights a gap in current care where a common, manageable side effect is often overlooked until it causes serious harm, and it points toward a future where checking blood sugar becomes a standard part of the cancer treatment routine.
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