关键词: 肿瘤相关性高血糖, 管理, 指南解读

Abstract: Malignant tumors and diabetes mellitus have gradually become the most common chronic non-communicable diseases in China. They are closely related. The risk, mortality and adverse prognosis of various malignant tumors in diabetic patients are significantly increased. Hyperglycemia in cancer patients is very common. From the aspect of etiology, some malignant tumors lead to hyperglycemia and/or diabetes, and hyperglycemia and/or diabetes can occur during the treatment of malignant tumors, including surgical stress, chemotherapeutic drugs, radiotherapy, glucocorticoids, a variety of targeted drugs and the application of immune checkpoint inhibitors, which is collectively referred to as tumor-associated hyperglycemia. Tumor-associated hyperglycemia is difficult to manage in clinical practice, and the quality of blood glucose control is closely related to the risk and adverse prognosis of patients with malignant tumor. However, there is currently no relevant guideline for the clinical diagnosis and management. Therefore, standardized management of malignant tumor-associated hyperglycemia is necessary. In view of this, the Onco- endocrinology Society of Chinese Anti-Cancer Association and Onco-endocrinology Society of Chong Qing Integrative Medicine Association have drafted Guidelines for the Management of Tumor-associated Hyperglycemia (2021 Edition), a comprehensive report based on the opinions of many domestic experts in oncology and endocrinology. In addition to summarizing the relationship between diabetes and multiple malignant tumors, the guidelines include the etiology of tumor-associated hyperglycemia/diabetes, the epidemiology of tumor-associated hyperglycemia, the concept of tumor-associated hyperglycemia, the diagnostic and differential diagnostic criteria and the standardized management of tumor-associated hyperglycemia, including the overall assessment methods and principles of tumor-associated hyperglycemia, individualized control objectives, management during clinical hospitalization (preadmission preparation, blood glucose management during hospitalization, insulin therapy, intensive care unit and non-intensive care unit management, ketoacidosis and hyperosmolar hyperglycemia, hypoglycemia treatment, perioperative blood glucose management, blood glucose management during enteral/parenteral nutrition, pregnancy with hyperglycemia or diabetes management, glucocorticoid application management, hospice care, transition from inpatient to outpatient, medication precautions, predischarge treatment, etc.), the impact of a variety of hypoglycemic drugs on malignant tumors, the impact of tumor therapeutic drugs on blood glucose and outpatient management, including the establishment of archives of patients with malignant tumors, health examination of blood glucose and complications, long-term follow-up and evaluation. In addition, combined with the actual medical situation in China, the guidelines provide two-way referral and graded diagnosis and treatment for patients with tumor-associated hyperglycemia and put forward relevant suggestions and standards to facilitate the convenient implementation of medical institutions and medical personnel at all levels. The guidelines put forward the corresponding classification of recommendations according to the principle of evidence-based medical evidence classification, which will help clinicians to rationalize and standardize the management of patients with tumor-associated hyperglycemia, so as to improve their clinical outcome and prognosis. Here, we made an interpretation of the contents and recommendations.

Key words: Tumor-associated hyperglycemia, Management, Interpretation of guidelines