Improving Diabetes Management in Older Adults with Cancer: A Quality Improvement Project to Enhance Monitoring During Steroid-Based Systemic Anti-Cancer Therapy

Improving Diabetes Management in Older Adults with Cancer: A Quality Improvement Project to Enhance Monitoring During Steroid-Based Systemic Anti-Cancer Therapy | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Improving Diabetes Management in Older Adults with Cancer: A Quality Improvement Project to Enhance Monitoring During Steroid-Based Systemic Anti-Cancer Therapy Evelyne Liuu, Rose Evans, Gitanjali Amaratunga, Sarah Compton, and 7 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8955982/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 5 You are reading this latest preprint version Abstract Purpose Older adults undergoing systemic anti-cancer therapy (SACT) with steroids are at high risk of developing steroid-induced hyperglycaemia (SIH). However, monitoring and management remain inconsistent. This quality improvement project (QIP) involved developing and evaluating the GOLD diabetes enhanced monitoring pathway, a multidisciplinary, age-adapted initiative for older patients at intermediate SIH risk. Methods The pathway was conducted at Guy’s and St Thomas’ NHS Foundation Trust from February 2022 to June 2025). It included structured risk stratification, home capillary blood glucose monitoring, diabetes education, and telephone follow-up by geriatric clinical nurse specialists. Iterative refinements were made through seven Plan-Do-Study-Act (PDSA) cycles. The primary outcome was the rate of diabetes medication intervention, while secondary outcomes included changes in SACT/steroid regimens, unplanned hospitalisations, and all-cause mortality. Results Of the 172 patients (55% male; mean age 70.9±8.3 years; 74% with pre-existing diabetes), 34% required diabetes medication intervention, primarily the initiation or escalation of gliclazide. Only three asymptomatic hypoglycaemic events occurred. Steroid dose reductions were significantly associated with medication intervention (72% vs 24%, p<0.001). Unplanned hospitalisations occurred in 28% of patients, with only two diabetes-related admissions. All-cause mortality (17%) was associated with male gender, metastatic disease, and malnutrition, but not to diabetes intervention or glycaemic control. Conclusion The GOLD pathway was found to be feasible, safe, and effective for managing SIH in older adults with cancer. Its success highlights the value of multidisciplinary collaboration and iterative refinement in addressing a critical gap in geriatric oncology care and supporting structured diabetes monitoring in clinical practice. older adults cancer diabetes steroid-induced hyperglycaemia quality improvement multidisciplinary care Figures Figure 1 Full Text Additional Declarations Tables 1 to 4 are available in the Supplementary Files section. Supplementary Files Table1.pdf Table2.pdf Table3.pdf Table4.pdf SQUIRE2.0checklist1.pdf Supplementaryinformation12.pdf Cite Share Download PDF Status: Under Review Version 1 posted Reviewers agreed at journal 22 Apr, 2026 Reviewers invited by journal 22 Apr, 2026 Editor invited by journal 03 Mar, 2026 Editor assigned by journal 26 Feb, 2026 First submitted to journal 24 Feb, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8955982","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":627718145,"identity":"06d35724-05fe-4150-ae70-381984a8ece6","order_by":0,"name":"Evelyne Liuu","email":"data:image/png;base64,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","orcid":"https://orcid.org/0000-0003-2758-5064","institution":"Poitiers University: Universite de Poitiers","correspondingAuthor":true,"prefix":"","firstName":"Evelyne","middleName":"","lastName":"Liuu","suffix":""},{"id":627718146,"identity":"ed79cb8d-72d8-47b7-a905-99f9ad93c911","order_by":1,"name":"Rose Evans","email":"","orcid":"","institution":"Guy's and St Thomas' NHS Foundation Trust","correspondingAuthor":false,"prefix":"","firstName":"Rose","middleName":"","lastName":"Evans","suffix":""},{"id":627718147,"identity":"ff4d3672-f824-4c98-be8d-a95c133a573e","order_by":2,"name":"Gitanjali Amaratunga","email":"","orcid":"","institution":"King's College London","correspondingAuthor":false,"prefix":"","firstName":"Gitanjali","middleName":"","lastName":"Amaratunga","suffix":""},{"id":627718148,"identity":"40594f5a-973e-4cec-8640-a261cccdadc5","order_by":3,"name":"Sarah Compton","email":"","orcid":"","institution":"Guy's and St Thomas' NHS Foundation Trust","correspondingAuthor":false,"prefix":"","firstName":"Sarah","middleName":"","lastName":"Compton","suffix":""},{"id":627718149,"identity":"145f8939-91ee-4838-8f0e-3089e098b202","order_by":4,"name":"Alexandros Georgiou","email":"","orcid":"","institution":"Guy's and St Thomas' NHS Foundation Trust","correspondingAuthor":false,"prefix":"","firstName":"Alexandros","middleName":"","lastName":"Georgiou","suffix":""},{"id":627718150,"identity":"cf6ab5f5-bde4-4cb3-b045-add8cb5e2cb4","order_by":5,"name":"Tania Kalsi","email":"","orcid":"","institution":"Guy's and St Thomas' NHS Foundation Trust","correspondingAuthor":false,"prefix":"","firstName":"Tania","middleName":"","lastName":"Kalsi","suffix":""},{"id":627718151,"identity":"d81765fd-8cc1-4cf6-bcac-af5d1f56a2ca","order_by":6,"name":"Yuk-Fun Liu","email":"","orcid":"","institution":"Guy's and St Thomas' NHS Foundation Trust","correspondingAuthor":false,"prefix":"","firstName":"Yuk-Fun","middleName":"","lastName":"Liu","suffix":""},{"id":627718152,"identity":"6438d686-8696-42e7-9887-865172cfd10c","order_by":7,"name":"James Maguire","email":"","orcid":"","institution":"Guy's and St Thomas' NHS Foundation Trust","correspondingAuthor":false,"prefix":"","firstName":"James","middleName":"","lastName":"Maguire","suffix":""},{"id":627718153,"identity":"3548cf34-cd81-4d70-9206-461309c87d0c","order_by":8,"name":"Clare Nottage","email":"","orcid":"","institution":"Guy's and St Thomas' NHS Foundation Trust","correspondingAuthor":false,"prefix":"","firstName":"Clare","middleName":"","lastName":"Nottage","suffix":""},{"id":627718154,"identity":"7dcfbdc0-2d93-48e3-b7a0-52e3fc632128","order_by":9,"name":"Hannah L. 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Steroid-Based Systemic Anti-Cancer Therapy\u003c/p\u003e","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"european-geriatric-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"EGEM","sideBox":"Learn more about [European Geriatric Medicine](https://www.springer.com/journal/41999)","snPcode":"41999","submissionUrl":"https://www.editorialmanager.com/egem/default2.aspx","title":"European Geriatric Medicine","twitterHandle":"","acdcEnabled":false,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"older adults, cancer, diabetes, steroid-induced hyperglycaemia, quality improvement, multidisciplinary care","lastPublishedDoi":"10.21203/rs.3.rs-8955982/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8955982/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003ePurpose \u003c/strong\u003eOlder adults undergoing systemic anti-cancer therapy (SACT) with steroids are at high risk of developing steroid-induced hyperglycaemia (SIH). However, monitoring and management remain inconsistent. This quality improvement project (QIP) involved developing and evaluating the GOLD diabetes enhanced monitoring pathway, a multidisciplinary, age-adapted initiative for older patients at intermediate SIH risk.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods \u003c/strong\u003eThe pathway was conducted at Guy’s and St Thomas’ NHS Foundation Trust from February 2022 to June 2025). It included structured risk stratification, home capillary blood glucose monitoring, diabetes education, and telephone follow-up by geriatric clinical nurse specialists. Iterative refinements were made through seven Plan-Do-Study-Act (PDSA) cycles. The primary outcome was the rate of diabetes medication intervention, while secondary outcomes included changes in SACT/steroid regimens, unplanned hospitalisations, and all-cause mortality.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults \u003c/strong\u003eOf the 172 patients (55% male; mean age 70.9±8.3 years; 74% with pre-existing diabetes), 34% required diabetes medication intervention, primarily the initiation or escalation of gliclazide. Only three asymptomatic hypoglycaemic events occurred. Steroid dose reductions were significantly associated with medication intervention (72% vs 24%, p\u0026lt;0.001). Unplanned hospitalisations occurred in 28% of patients, with only two diabetes-related admissions. All-cause mortality (17%) was associated with male gender, metastatic disease, and malnutrition, but not to diabetes intervention or glycaemic control.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion \u003c/strong\u003eThe GOLD pathway was found to be feasible, safe, and effective for managing SIH in older adults with cancer. Its success highlights the value of multidisciplinary collaboration and iterative refinement in addressing a critical gap in geriatric oncology care and supporting structured diabetes monitoring in clinical practice.\u003c/p\u003e","manuscriptTitle":"Improving Diabetes Management in Older Adults with Cancer: A Quality Improvement Project to Enhance Monitoring During Steroid-Based Systemic Anti-Cancer Therapy","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-05-04 09:44:35","doi":"10.21203/rs.3.rs-8955982/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"","date":"2026-04-22T18:05:13+00:00","index":0,"fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-22T11:43:36+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"European Geriatric Medicine","date":"2026-03-03T18:30:47+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-02-26T16:11:26+00:00","index":"","fulltext":""},{"type":"submitted","content":"European Geriatric Medicine","date":"2026-02-25T02:53:05+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"european-geriatric-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"EGEM","sideBox":"Learn more about [European Geriatric Medicine](https://www.springer.com/journal/41999)","snPcode":"41999","submissionUrl":"https://www.editorialmanager.com/egem/default2.aspx","title":"European Geriatric Medicine","twitterHandle":"","acdcEnabled":false,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"b92458b6-90c3-4467-ba26-2b90751f9097","owner":[],"postedDate":"May 4th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-04T09:44:35+00:00","versionOfRecord":[],"versionCreatedAt":"2026-05-04 09:44:35","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8955982","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8955982","identity":"rs-8955982","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}