Blood cancers

Hidden diabetes in haematology patients revealed

An initiative to improve inpatient care and ascertain the prevalence of diabetes at Austin Health has found 28% of haematology and cancer patients have either known or previously undiagnosed diabetes.

As part of the Diabetes Discovery Initiative, more than 1,000 patients from 54-years-of-age and admitted to the haematology and oncology units of the hospital underwent HbA1c testing.

The study found 21% had known diabetes and a further 7% had previously unrecognised diabetes on the basis of HbA1c >6.5%.

Patients with known diabetes had a longer length of stay than other patients but other outcomes such as ICU admission, 30-day and 18-month readmissions or 18-month mortality were not significantly different based on diabetes status.

About 43% of patients had been exposed to glucocorticoids during the 365 days prior to their admission.

Endocrinologist Associate Professor Elif Ekinci told the limbic that corticosteroid use in the doses that are required as part of cancer treatment puts people at high risk of developing diabetes or hyperglycaemia.

“This is quite important because if the diabetes is unrecognised then the hyperglycaemia can lead to severe complications such as hyperglycaemic crises”

“What we have done here, as part of the Diabetes Discovery Initiative at the Austin, helps to identify these high-risk people. In the past this has probably not been recognised as being as important in the context of the urgency and sometimes severity of the cancer treatment that needs to take place.”

She said knowledge of high HbA1c levels in patients could influence treatment decisions as well as their hospital outcomes.

“It is an important initiative and at our hospital everybody is engaged and there is a lot of ongoing education involved, especially with the junior doctors and the junior staff.”

“Sometimes it makes a big change in terms of a patient with previously undiagnosed diabetes who might otherwise be put on glucocorticoids on discharge. But now they know, they can be seen by the diabetes nurse educator and commenced often on insulin because of the high glucocorticoids as well as tablets. It’s an important aspect of the inpatient management.”

“We can’t interfere with the steroid use especially as for some people it is an essential part of their management. So that’s not really our job but it is our job to try to manage people who have unrecognised diabetes to prevent complications. Our goal is more to support the treating units.”

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