National Survey of the JBDS-IP/UK SACT board guidelines on the management of glycaemia

Introduction : Systemic anti-cancer therapy (SACT) is reported to be associated with hyperglycaemia, in those people with or at risk of diabetes. Causes for the association can be a resultant effect of corticosteroids used both as part of treatment and in antiemetic protocols. Additionally, some SACT may cause hyperglycaemia ¹ . The Joint British Diabetes Societies (JBDS) and UK SACT board guideline on the management of glycaemic control in people with cancer, recommends monitoring of blood glucose and prompt management of glycaemia. However, the implementation of these guidelines has not been evaluated, and it is not known whether oncologists have the capacity to undertake this work. Method : A survey was developed to explore participant’s awareness of the national guidelines, the implementation model adopted (full/partial), implementation challenges and measures to overcome these. The average content validity index for the instrument was assessed by an expert panel of four clinicians, and a snowball-sampling technique was used to target healthcare professional across the country. The survey was administered to clinicians working at an institution delivering systematic anticancer therapy to adult cancer between 18th November 2024 and 6th January 2025. Results : Responses were received from 174 clinicians from 67 institutions, covering 27% of hospitals providing cancer services in the UK. 45% of clinicians were aware of the JBDS/UK SACT board guidelines, with 18% finding their implementation very important. However, only 30 out of 67 hospitals surveyed had implemented national guidance: 13 fully and 17 partially. In institutions with partial adoption, monitoring was restricted to cancer patients with the highest risk of hyperglycaemia; symptoms of hyperglycaemia without known diabetes (43%,9/21) or with pre-existing diabetes (9%, 2/21). Organisational barriers included gaps in diabetes training, inability to supply glucose testing equipment, staff shortages, and poor governance. External factors were difficulty agreeing a pathway with community providers of diabetes care, implementation costs (such as monitoring, and recruitment) and an evidence gap for embedding diabetes clinics in cancer centres. Strategies to overcome these challenges included staff training on diabetes, establishing a pathway with primary care & improved governance. Conclusion : Most institutions have not implemented national guidance although some have adopted measures to target those most at risk of hyperglycaemia. However, as the UK population ages the prevalence of multi-morbidity, especially diabetes and cancer will increase, and we advocate for a national implementation strategy.