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Glucocorticoid-induced hyperglycemia in oncologic outpatients: a narrative review using the Quadruple Aim framework

  • Ihab Kandil
    Affiliations
    Department of Medicine, The Ottawa Hospital, 501 Smyth Road, Box 206, Ottawa, Ontario, Canada, K1H 8L6
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  • Erin Keely
    Correspondence
    Corresponding Author: Erin Keely, MD Professor, Department of Medicine, University of Ottawa Division of Endocrinology and Metabolism The Ottawa Hospital, Riverside Campus 1967 Riverside Drive, Ottawa ON, Canada, K1H 7W9 Telephone: 613-798-5555 ext. 81946 Fax: 613-738-8327
    Affiliations
    Division of Endocrinology and Metabolism, The Ottawa Hospital, Riverside Campus, 1967 Riverside Drive, Ottawa, Ontario, Canada, K1H 7W9
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Published:March 08, 2022DOI:https://doi.org/10.1016/j.jcjd.2022.02.011
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      ABSTRACT:

      Background

      Glucocorticoids are a central part of cancer treatment protocols. Their use in patients receiving chemotherapy increases their risk of hyperglycemia and associated adverse outcomes. Despite this, there have been few published protocols that guide the management of this patient group. In this narrative review, we use the Quadruple Aim as a framework to evaluate the current literature, including interventions, on glucocorticoid-induced hyperglycemia in patients receiving oncologic treatment, with a focus on the outpatient setting.

      Methods

      Findings were drawn from published review articles, observational studies, qualitative reports, as well as costing data. Results were synthesized using the framework’s four dimensions of care: population health, provider experience, patient experience and cost. Prospective studies proposing an intervention on oncologic patients receiving glucocorticoids were identified as intervention studies.

      Results

      Management of glucocorticoid-induced hyperglycemia in oncologic patients is a complex problem with no published interventions addressing all components of the Quadruple Aim. Most evidence on this population is based on retrospective studies. Six prospective intervention studies were identified and highlighted in this review, only two were exclusively in the outpatient context. Challenges included lack of standardization in screening strategies, paucity of interventions that have examined impact on patient and provider experience. Evaluation of clinical outcomes associated with glycemic intervention as well cost is limited, especially in the outpatient context. We propose a conceptual framework for evaluation of quality improvement programs.

      Conclusion

      Management of glucocorticoid induced hyperglycemia in the outpatient setting is complex and requires well designed intervention studies evaluated across the Quadruple Aim.

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