Graduation Date

Fall 12-18-2020

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Programs

Nursing

First Advisor

Ann M. Berger

Abstract

Patients with cancer experience metabolic changes such as hypoglycemia, hyperglycemia, and glycemic variability; collectively termed malglycemia. Glycemic variability, defined as fluctuations in glucose, is a marker of metabolic instability. Higher glycemic variability is associated with adverse health outcomes in the general population and in those with diabetes. Little is known about glycemic variability in patients with cancer, especially those with solid tumor malignancies. Glycemic variability is associated with increased infection, shorter periods of remission, and higher mortality in patients with hematological cancer. This body of work describes the concept and measurement of glycemic variability to assess glycemic control in patients with cancer, provides a review of glycemic variability in patients with gastrointestinal cancer, and presents results from research of glycemic variability in patients with stage II-III colon cancer. The purpose of this retrospective, longitudinal study was to examine glycemic variability within one year following surgery among patients treated with or without chemotherapy for stage II-III colon cancer. Glycemic variability was measured as standard deviation (SD) and % coefficient of variation (CV). Serial glucose values were used to assess glycemic variability within one month following surgery, throughout chemotherapy, and within one year following surgery. Patients with diabetes had significantly higher glycemic variability within one month following surgery, throughout chemotherapy, and within one year following surgery compared to patients without diabetes. Patients without diabetes experienced a significant rise in glycemic variability throughout 12 cycles of chemotherapy; a finding not observed in patients with diabetes. Numerous associations between demographic and clinical characteristics and glycemic variability were observed; these associations varied by preoperative diabetes status, method of measurement (SD or CV), and timing of assessment. Preoperative diabetes or higher preoperative glucose values was associated with higher glycemic variability within one month and at year following surgery. The pre-chemotherapy glucose value was not associated with glycemic variability throughout adjuvant chemotherapy. Results suggest that all patients with stage II-III colon cancer, especially those with diabetes, are at-risk for higher glycemic variability following surgery and throughout adjuvant chemotherapy. This dissertation provides a foundation for future research focused on improving glycemic variability in at-risk patients receiving cancer treatments.

Additional Files
Journal Author Copyrights Policies _ Elsevier_European Journal of Oncology Nursing.pdf (691 kB)
Permission to Use Published Work_Elsevier
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