Trajectories of Fasting Blood Glucose in Autologous Hematopoietic Cell Transplantation.
Marilyn J Hammer, Steven M Paul, Amir Steinberg and 3 others
PMID 30024438WHAT IT FOUND
Fasting glucose rose through day 6 after autologous hematopoietic cell transplant in patients without diabetes, then declined.
But trajectories varied widely. BMI and pre-transplant glucose predicted starting levels.
Key findings
01Fasting blood glucose rose from day 0 through day 6 post-transplant, then declined over the remaining days.
02BMI and pre-transplant fasting glucose predicted differences in starting glucose levels, and pre-transplant fasting glucose predicted the rate of change.
03Insulin was administered only 14 times over 3,211 patient days.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Only 53 patients were analysed, and substantial variability remained, so the findings may not apply to other transplant populations. Patients with pre-existing diabetes were excluded, and all had a comorbidity risk score of 0, so this does not describe higher-risk transplant patients. No follow-up point-of-care glucose testing after insulin was collected, and insulin was used only 14 times over 3,211 patient days, so treatment response was not assessed. Results cannot be generalized to patients who receive an allogeneic hematopoietic cell transplant. The study did not test whether glucose monitoring or any intervention prevented infection.
Declared interests
The authors disclosed no conflicts of interest. The paper is listed as NIH extramural research support.
The easy way to misread this
Do not conclude that closer glucose monitoring or insulin prevents infection. This was an observational study of 53 patients without diabetes, and it measured glucose trajectories and predictors, not an infection outcome. The rise through day 6 was an average pattern, and individual trajectories varied widely.