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Impact of Malglycemia on Clinical Outcomes in Hospitalized Patients With Cancer: A Review of the Literature

Susan Storey
Diane Von Ah
ONF 2012, 39(5), 458-465 DOI: 10.1188/12.ONF.458-465

Purpose/Objectives: To examine empirical research regarding the role of malglycemia (hyperglycemia, hypoglycemia, or glycemic variability) on clinical outcomes among hospitalized patients with cancer.

Data Sources: Research articles were obtained from the Ovid, PubMed, and CINAHL® databases. Key words used in the search included hyperglycemia or malglycemia and neoplasm combined with venous thromboembolism, infection, or mortality.

Data Synthesis: Eleven research articles were examined reporting the impact of malglycemia on various outcomes, including infection, mortality or survival, length of hospital stay, and toxicity.

Conclusions: Findings suggest that malglycemia may have a negative impact on outcomes for hospitalized patients with cancer. Increased rates of infection, mortality, length of stay, and toxicities, as well as decreased survival, were reported.

Implications for Nursing: Oncology nurses play an important role in the identification of patients with malglycemia. Early assessment and intervention for those patients can improve outcomes and quality of life.


Ali, N. A., O'Brien, J. M., Blum, W., Byrd, J. C., Klisovic, R. B., Marcucci, G., … Grever, M. R. (2007). Hyperglycemia in patients with acute myeloid leukemia is associated with increased hospital mortality. <i>Cancer, 110</i>, 96-102. doi:10.1002/cncr.22777

Ali, N. A., O'Brien, J. M., Dungan, K., Phillips, G., Marsh, C. B., Lemeshow, S., … Preiser, J. (2008). Glucose variability and mortality in patients with sepsis. <i>Critical Care Medicine, 36</i>, 2316-2321. doi:10.1097/CCM.0b013e3181810378

Barone, B. B., Yeh, H. C., Snyder, C. F., Peairs, K. S., Stein, K. B., Derr, R. L., … Brancati, F. L. (2008). Long-term all-cause mortality in cancer patients with preexisting diabetes mellitus: A systematic review and meta-analysis. <i>JAMA, 300</i>, 2754-2764. doi:10.1001/jama.2008.824

Benfield, T., Jensen, J. S., & Nordestgaard, B. G. (2007). Influence of diabetes and hyperglycaemia on infectious disease hospitalisation and outcome. <i>Diabetologia, 50</i>, 549-554. doi:10.1007/s00125-006-0570-3

Brunello, A., Kapoor, R., & Extermann, M. (2010). Hyperglycemia during chemotherapy for hematologic and solid tumors is correlated with increased toxicity. <i>American Journal of Clinical Oncology, 34</i>, 293-296. doi:10.1097/COC.0b013e3181e1d0c0

Carr, M. (2001). Diabetes mellitus: A hypercoaguable state. <i>Journal of Diabetes and Its Complications, 15</i>, 44-54. doi:10.1016/S1056-8727(00)00132-X

Derr, R. L., Hsiao, V. C., & Saudek, C. D. (2008). Antecedent hyperglycemia is associated with an increased risk of neutropenic infections during bone marrow transplantation. <i>Diabetes Care, 31</i>, 1972-1977. doi:10.2337/dc08-0574

Derr, R. L., Ye, X., Islas, M. U., Desideri, S., Saudek, C. D., & Grossman, S. A. (2009). Association between hyperglycemia and survival in patients with newly diagnosed glioblastoma. <i>Journal of Clinical Oncology, 27</i>, 1082-1086. doi:10.1200/JCO.2008.19.1098

Dossett, L. A., Cao, H., Mowery, N. T., Dortch, M. J., Morris, J. M., & May, A. K. (2008). Blood glucose variability is associated with mortality in the surgical intensive care unit. <i>American Surgeon, 74</i>, 679-685.

Egi, M., Bellomo, R., Stachowski, E., French, C. J., & Hart, G. (2006). Variability of blood glucose concentration and short-term mortality in critically ill patients. <i>Anesthesiology, 105</i>, 244-252. doi:10.1097/00000542-200608000-00006

Fugi, S., Kim, S., Mori, S., Kamiya, S., Yoshimura, K., Yokoyama, H., … Fukuda, T. (2009). Intensive glucose control after allogeneic hematopoietic stem cell transplantation: A retrospective matched-cohort study. <i>Bone Marrow Transplantation, 44</i>, 105-111. doi:10.1038/bmt.2008.431

Fugi, S., Kim, S. W., Mori, S., Fukuda, T., Kamiya, S., Yamasaki, S., … Takaue, Y. (2007). Hyperglycemia during the neutropenia period is associated with a poor outcome in patients undergoing myeloablative allogeneic hematopoietic stem cell transplantation. <i>Transplantation, 84</i>, 814-820. doi:10.1097/01.tp.0000296482.50994.1c

Garg, R., Bhutani, H., Alyea, E., & Pendergrass, M. (2007). Hyperglycemia and length of stay in patients hospitalized for bone marrow transplantation. <i>Diabetes Care, 30</i>, 993-994. doi:10.2337/dc06-2563

Hammer, M. J., Casper, C., Gooley, T. A., O'Donnell, P. V., Boeckh, M., & Hirsch, I. B. (2009). The contribution of malglycemia to mortality among allogeneic hematopoietic cell transplant recipients. <i>Biology of Blood and Marrow Transplantation, 15</i>, 344-351. doi:10.1016/j.bbmt.2008.12.488

Hardy, S. J., Nowacki, A. S., Bertin, M., & Weil, R. J. (2010). Absence of an association between glucose levels and surgical site infections in patients undergoing craniotomies for brain tumors. <i>Journal of Neurosurgery, 113</i>, 161-166. doi:10.3171/2010.2.JNS09950

Hermanides, J., Vriesendorp, T. M., Bosman, R. J., Zandstra, D. F., Hoekstra, J. B., & DeVries, J. H. (2010). Glucose variability is associated with intensive care unit mortality. <i>Critical Care Medicine, 38</i>, 838-842. doi:10.1097/CCM.0b013e3181cc4be9

Kent, T., Soukup, V., & Fabian, R. (2001). Heterogeneity affecting outcome from acute stroke therapy: Making reperfusion worse. <i>Stroke, 32</i>, 2318-2327. doi:10.1161/hs1001.096588

Kreutziger, J., Schlaepfer, J., Wenzel, V., & Constantinescu, M. A. (2009). The role of admission blood glucose in outcome prediction of surviving patients with multiple injuries. <i>Journal of Trauma, 67</i>, 704-708. doi:10.1097/TA.0b013e3181b22e37

Krinsley, J. S. (2004). Effect of intense glucose management protocol on the mortality of critically ill adult patients. <i>Mayo Clinic Proceedings, 79</i>, 992-1000. doi:10.4065/79.8.992

Marchant, M. H., Viens, N. A., Cook, S., Vail, T. P., & Bolognesi, M. P. (2009). The impact of glycemic control and diabetes mellitus on perioperative outcomes after total joint arthroplasty. <i>Journal of Bone and Joint Surgery, 91</i>, 1621-1629. doi:10.1097/CCM.0b013e3181810378

Melynk, B. M. (2004). Integrating levels of evidence into clinical decision making. <i>Pediatric Nursing, 30</i>, 323-324.

Mraovic, B., Hipzer, B. R., Epstein, R. H., Pequignot, E. C., Parvizi, J., & Joseph, J. I. (2010). Preadmission hyperglycemia is an independent risk factor for in-hospital symptomatic pulmonary embolism after major orthopedic surgery. <i>Journal of Arthroplasty, 25</i>, 64-70. doi:10.1016/j.arth.2008.10.002

National Cancer Institute. (2006). <i>Common Toxicity Criteria for Adverse Events</i> [v3.0]. Retrieved from <a target="_blank" href='http://ctep.cancer.gov/protocoldevelopment/electronic_applications/docs/...

Sheean, P. M., Freels, S. A., Helton, W. S., & Braunshweig, C. A. (2006). Adverse clinical consequences of hyperglycemia from total parenteral nutrition exposure during hematopoietic stem cell transplantation. <i>Biology of Blood and Marrow Transplantation, 12</i>, 656-664. doi:10.1016/j.bbmt.2006.01.010

Umpierrez, G. E., Isaacs, S. D., Bazargan, N., You, X., Thaler, L. M., & Kitababchi, A. E. (2002). Hyperglycemia: An independent marker of in-hospital mortality in patients with undiagnosed diabetes. <i>Journal of Clinical Endocrinology and Metabolism, 87</i>, 978-982.

Van den Berghe, G., Wouters, P., Weekers, F., Verwaest, C., Bruyninickx, F., Schetz, M., … Bouillon, R. (2001). Intensive insulin therapy in critically ill patients. <i>New England Journal of Medicine, 345</i>, 1359-1367. doi:10.1210/jc.2009-0663

Von Ah, D., Kang, D. H., & Carpenter, J. (2008). Predictors of cancer-related fatigue in women with breast cancer prior to, during, and after adjuvant therapy. <i>Cancer Nursing, 31</i>, 134-144. doi:10.1097/01.NCC.0000305704.84164.54

Weiser, M. A., Cabanillas, M. E., Konopleva, M., Thomas, D. A., Pierce, S. A., Escalante, C. P., … O'Brien, S. M. (2004). Relation between the duration of remission and hyperglycemia during induction chemotherapy for acute lymphocytic leukemia with a hyper-fractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone/methotrexate cytarabine regimen. <i>Cancer, 100</i>, 1179-1185. doi:10.1002/cncr.20071

Zeng, L., Biernacka, K. M., Holly, J. M., Jarrett, C., Morrison, A. A., Morgan, A., … Perks, C. M. (2010). Hyperglycaemia confers resistance to chemotherapy on breast cancer cells: The role of fatty acid synthase. <i>Endocrine-Related Cancer, 17</i>, 539. doi:10.1677/ERC-09-0221