WhatsappOBJECTIVES: During intensive hematological care, patients are exposed to high-dose chemotherapy, corticosteroids, immunosuppressants and total parenteral nutrition. Combined with physiological stress and increased release of cytokines and hormones, this can lead to dysglycemia, which is associated with adverse clinical outcomes. This prospective study aims to investigate continuous glucose monitoring (CGM) to identify dysglycemia during intensive hematological care.
METHODS: Patients receiving chimeric antigen receptor (CAR) T-cell therapy, allogeneic or autologous stem cell transplantation (SCT) were eligible. Throughout the study, glucose levels were concurrently monitored using CGM and point-of-care (POC) glucose measurements in sixty patients (71% male, median age of 64 (IQR [58-68]) years and 10% with diabetes).
RESULTS: Hyperglycemia (glucose >10mmol/L) was prevalent in 93% of patients, of which 90% had no history of diabetes. Severe hyperglycemia (glucose >13.1mmol/L) was present in 38%. Additionally, hyperglycemia was associated with prolonged hospitalization in patients undergoing CAR T-cell treatment (β=0.19, 95% CI=0.04-0.35) and autologous SCT (β=0.16, 95% CI=0.01-0.32). CGM outperformed POC in detecting hyperglycemia (>10 mmol/L: 1060 vs. 124, detected 2.8 hours (IQR [0.7-4.0]) earlier). Mean absolute relative difference between CGM and POC was 21.5% with 99.8% of measurements in the clinical acceptable zones 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 hematological care.