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Trajectories of Fasting Blood Glucose in Autologous Hematopoietic Cell Transplantation

Hammer, Marilyn J., PhD, DC, RN, FAAN; Paul, Steven M., PhD; Steinberg, Amir, MD, FACP; Eckardt, Patricia, PhD, RN; Barton-Burke, Margaret, PhD, RN, FAAN; Miaskowski, Christine, PhD, RN, FAAN

doi: 10.1097/NCC.0000000000000627
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Background Patients who receive autologous hematopoietic cell transplantation (HCT) for the treatment of hematologic malignancies are at risk of serious adverse outcomes including infections and death. Hyperglycemia following the HCT is associated with increased risk of these adverse outcomes. However, limited information is available on demographic and clinical characteristics that contribute to changes in blood glucose levels following HCT.

Objective The objective of this study was to determine the trajectories of fasting blood glucose (FBG) levels as well as the demographic and clinical characteristics that predicted interindividual differences in these FBG trajectories.

Methods A sample of adult patients with hematologic malignancies who were scheduled to receive autologous HCT (n = 53) was enrolled in the study. Patients with preexisting diabetes were excluded. Demographic and clinical characteristics were abstracted from electronic medical records. Morning fasting laboratory tests (ie, FBG and absolute neutrophil counts) were obtained. Data were analyzed using hierarchical linear modeling from the day of HCT (day 0) through 14 days post-HCT.

Results Among 8 characteristics evaluated, pre-HCT FBG was associated with variability in both the initial levels and the trajectories of FBG. Body mass index was only associated with initial levels of FBG.

Conclusions The large amount of interindividual variability in the trajectories of FBG levels following autologous HCT suggests that glucose control in these patients warrants ongoing assessments and preemptive tailoring.

Implications for Practice Fasting blood glucose monitoring is warranted. Additional research with larger samples is warranted to identify additional modifiable and nonmodifiable characteristics associated with interindividual variability in FBG levels.

Author Affiliations: Department of Nursing, Mount Sinai Hospital, New York (Dr Hammer); Department of Physiological Nursing, School of Nursing, University of California San Francisco (Drs Paul and Miaskowski); and Icahn School of Medicine, Mount Sinai Hospital (Dr Steinberg); Heilbrunn Family Center for Research Nursing, Rockefeller University (Dr Eckardt); and Department of Nursing, Memorial Sloan Kettering Cancer Center (Dr Barton-Burke), New York.

This study was funded by a grant from the National Institute of Nursing Research (K23NR012467). Other support was from the Memorial Sloan Kettering Cancer Center Core Grant (P30 CA008748).

The authors have no conflicts of interest to disclose.

Correspondence: Marilyn J. Hammer, PhD, DC, RN, FAAN, Department of Nursing, Mount Sinai Hospital, One Gustave L. Levy Place, Box 1168, New York, NY 10029 (marilyn.hammer@mountsinai.org).

Accepted for publication April 18, 2018.

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