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Why and How We Developed Consensus Guidelines for Diabetes management in Cancer Patients (#115)

Kathleen Steele 1 , Elizabeth Mulrooney 1 , Laita Bokhari 1 , Richard MacIsaac 1 , Peter Colman 2 , Sue Anne McLachlan 1 , Mark Rosenthal 2 , Glenn Ward 1 , Lesa Stewart 1 , Carmel Parlapiano 2 , Katie Marley 2 , Andrew Cording 1 , Graeme Giles 3 , Katerina Kiburg 1 , Sue Kirsa 4
  1. St Vincent's Public Hospital Melbourne, Fitzroy, VIC, Australia
  2. Diabetes & Endocrinology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
  3. Consumer, Melbourne, Victoria, Australia
  4. Western & Central Melbourne Integrated Cancer Service, Melbourne, Victoria, Australia

Rationale: Diabetes is common in patients with cancer. Steroids are frequently part of cancer regimens. Surprisingly there are no guidelines to guide clinicians in management of diabetes or screening for diabetes in this patient group. We undertook developing guidelines unique to diabetes care in cancer patients

Aim:

To develop consensus best practice guidelines for standardised care of cancer patients at high risk of developing diabetes, already diagnosed with diabetes, or on high dose steroids.

Method: A Steering Committee formed including a consumer, cancer and diabetes experts, and stakeholders from two health services. A retrospective audit of patients attending the cancer centres over a 3 month period was completed to identify clinical management.

Case studies were developed by two Oncologists. Experts completed a unique online survey to identify consensus current best practice. The Steering committee extensively workshopped clinical scenarios and developed draft guidelines.   These were presented as flow charts to best communicate the clinical management recommendations. and included referral pathways, pathology tests, insulin initiation and titration algorithms, screening, managing newly diagnosed diabetes including Glucocorticoid induced diabetes, nausea, vomiting, hypoglycaemia and hyperglycaemia.

The guidelines were presented to an advertised special presentation at the 2015 Diabetes Scientific Meeting. Feedback using smart phone technology was sought about key aspects of the guidelines. The guidelines were modified and reviewed at a National Association of Diabetes Centres Meeting. Consensus approval was achieved using the Modified Delphi Technique.

Using locally developed protocols, each health service piloted and evaluated the new guidelines.

Conclusion:

Locally adaptable, new consensus guidelines were developed using a consensus approach based on the Modified Delphi Technique. These provide options for standardised care for cancer patients with diabetes.

Acknowledgement: The project was funded by the Western Central Melbourne Integrated Cancer Services (WCMICS)

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