Using CGM to Evaluate Hyperglycemia in Patients with Early Stage Breast Cancer

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In a study presented at ASCO 2024, investigators found that all 20 included patients with early stage breast cancer receiving chemotherapy developed hyperglycemia.

There is a high prevalence of hyperglycemia among patients with early stage breast cancer who are receiving treatment with chemotherapy, according to research presented at the American Society of Clinical Oncology 2024 Annual Meeting, held May 31 to June 4 in Chicago, Illinois.1 The data also showed that the time patients spent in hyperglycemia was markedly different depending on baseline A1c levels.

Using CGM to Evaluate Hyperglycemia in Patients with Early Stage Breast Cancer / Dragoljub - stock.adobe.com

Using CGM to Evaluate Hyperglycemia in Patients with Early Stage Breast Cancer / Dragoljub - stock.adobe.com

Over the past 4 decades, the incidence of breast cancer in the United States has risen by about 0.5% each year.2 According to data from the National Cancer Institute, there have so far been 310720 news cases of female breast cancer in 2024, which represents 15.5% of all new cancer cases in the country. Although breast cancer rates have been increasing, the death rate has been steadily decreasing. Breast cancer has a 91.2% 5-year survival rate.3

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Hyperglycemia, which occurs when there is too much sugar in the blood, is known to increase the risk of breast cancer development. But the condition can also increase mortality in patients with breast cancer and can have a negative impact on the efficacy of chemotherapy.4 However, the prevalence and daily patterns of hyperglycemia in patients with early stage breast cancer are currently unknown.

Investigators from the Vagelos College of Physicians and Surgeons at Columbia University conducted a prospective, single-arm pilot study that used continuous glucose monitoring (CGM) to determine the prevalence of hyperglycemia in patients with early stage breast cancer receiving chemotherapy. The most common chemotherapy regimens included docetaxel/cyclophosphamide, weekly paclitaxel and trastuzumab, paclitaxel followed by doxorubicin/cyclophosphamide, docetaxel/carboplatin/trastuzumab/pertuzumab, and cyclophosphamide/methotrexate/fluorouracil.

The study cohort included 20 adult patients with early stage breast cancer who received chemotherapy between December 2020 and February 2022. Patients wore a CGM from the time of chemotherapy initiation until their treatment was completed. The study’s primary endpoints were prevalence of hyperglycemia and proportion of time spent in hyperglycemia. Secondary endpoints included prevalence of prediabetes and diabetes at baseline, as well as changes in A1c from baseline to weeks 12 and 24.

At baseline, 10 patients were euglycemic, 7 had prediabetes, and 3 had diabetes. During the study period, all 20 patients developed hyperglycemia. Out of 124165 CGM readings collected, 17% were 140 mg/dL or greater and mean glucose was 112.7 mg/dL. The diabetes group had the highest proportion of time spent in hyperglycemia at 73.3%, followed by the prediabetes group at 10%, and the euglycemic group at 3.9%.

The diabetes group also had the highest mean glucose values at 183.0 mg/dL, followed by the prediabetes group at 104.5 mg/dL, and the euglycemic group at 95.5 mg/dL. Additionally, the change in mean A1c levels varied significantly between the groups from baseline to weeks 12 and 24.

“Among patients receiving chemotherapy for early stage breast cancer, we found evidence of hyperglycemia in all patients, and the proportion of time spent hyperglycemic during chemotherapy varied significantly by baseline A1c,” the authors concluded. “Further interventions should evaluate the benefits of improved glucose control among patients with baseline A1c > 5.7%.”

READ MORE: ASCO 2024 Annual Meeting Coverage

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References
1. Ulene S, Wang S, Cook J, et al. Continuous glucose monitoring and rates of hyperglycemia during chemotherapy for early-stage breast cancer. Presented at: ASCO 2024; June 1-4, 2024; Chicago, IL.
2. Giaquinto AN, Sung H, Miller KD, et al. Breast Cancer Statistics, 2022. CA Cancer J Clin. 2022 Nov;72(6):524-541. doi: 10.3322/caac.21754. Epub 2022 Oct 3. PMID: 36190501.
3. Cancer Stat Facts: Female Breast Cancer. NIH. Accessed June 11, 2024. https://seer.cancer.gov/statfacts/html/breast.html
4. Qiu J, Zheng Q, Meng X. Hyperglycemia and Chemoresistance in Breast Cancer: From Cellular Mechanisms to Treatment Response. Front Oncol. 2021 Feb 25;11:628359. doi: 10.3389/fonc.2021.628359. PMID: 33718202; PMCID: PMC7947364.
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