Therapeutic management of hyperglycemia in cancer patients in hospital

Diabetes and cancer are an increasingly common combination and managing oncologic patients with diabetes as a co-morbidity is often complicated. Diabetes has been linked to an increased risk of different cancer types, and coexisting diabetes confers a greater risk of mortality for many malignancies. Diabetes in cancer patients poses several complex questions about management, including what level of glycemic control should be achieved in persons who may have a limited life expectancy, and what is the best therapeutic approach to control hyperglycemia. Glucocorticoids and artificial nutrition, frequently used in cancer treatment, can lead to acute episodes of hyperglycemia. The first important distinction to be made is the patient's position on the trajectory of the oncologic illness. The management of diabetes during terminal illness is also complex, when the aim of care is to improve and maintain quality of life, maximizing comfort. Severe hyperglycemia and hypoglycemia can both impair the quality of life of these patients. In the clinical setting, in hospital or at home, there is little evidence-based guidance on the best course of management on which to base clinical decisions. A practical solution is to set up care networks based on communication and continuous collaboration between oncologists, endocrinologists, and nursing staff, with the patient at the center of the care process.