Background: Diabetes negatively impacts cancer prognosis. The objective of this work was to evaluate a tripartite oncologist–pharmacist–diabetologist collaboration in the management of patients with diabetes starting chemotherapy. Patients and Methods: The prospective ONCODIAB study (NCT04315857) included 102 adults with diabetes starting chemotherapy by whom a continuous glucose monitoring device was worn for fourteen days from the first day of the first and second chemotherapy cycles. The primary outcome was to assess pharmacist and diabetologist interventions. The secondary outcome was to evaluate the impact of the ONCODIAB follow-up on individualized patient glycemic targets at 6 months. Results: A total of 191 (2 per patient) were made either by clinical pharmacists (n= 95) or diabetologists (n= 96) during the first two chemotherapy cycles. The anatomic therapeutic chemical drug classes most frequently involved in pharmacist interventions were cardiovascular system (23%), alimentary tract and metabolism (22%), and anti-infectives for systemic use (14%). Diabetologists modified the antidiabetic treatment in 58 (62%) of patients: dose reduction (34%), drug discontinuation (28%), drug addition (24%), and dose increase (15%). Glycated hemoglobin decreased from 7.6 ± 1.7% at baseline to 7.1 ± 1.1% at 6 months (p= 0.02). Compared to individualized targets, HbA1c was higher, in the interval, or lower in 29%, 44%, and 27% of patients at baseline vs. in 8%, 70%, and 22% of patients at 6 months, respectively (p< 10−3). Conclusions: In our study, a close collaboration between oncologists, pharmacists, and diabetologists helped by continuous glucose monitoring led to overall medication optimization and better glycemic control in patients with diabetes starting chemotherapy.
背景：糖尿病对癌症预后具有负面影响。本研究旨在评估肿瘤科医生、药剂师与糖尿病专科医生三方协作模式在糖尿病患者启动化疗期间的管理效果。患者与方法：前瞻性ONCODIAB研究（NCT04315857）纳入102例即将开始化疗的成年糖尿病患者，患者在首个及第二个化疗周期起始日分别佩戴连续血糖监测设备14天。主要结局指标为评估药剂师与糖尿病专科医生的临床干预措施；次要结局指标为评估ONCODIAB随访模式对患者6个月个体化血糖控制目标的影响。结果：在前两个化疗周期中，临床药剂师（n=95）与糖尿病专科医生（n=96）共实施191项干预措施（平均每例患者2项）。药剂师干预涉及频率最高的解剖治疗化学药物分类为心血管系统药物（23%）、消化系统与代谢药物（22%）及全身用抗感染药物（14%）。糖尿病专科医生对58例（62%）患者调整降糖方案：剂量下调（34%）、停药（28%）、加用新药（24%）及剂量上调（15%）。糖化血红蛋白从基线期的7.6±1.7%降至6个月时的7.1±1.1%（p=0.02）。相较于个体化控制目标，基线期患者HbA1c高于、处于及低于目标区间的比例分别为29%、44%和27%，至6个月时该比例分别转变为8%、70%和22%（p<10^-3）。结论：本研究表明，通过连续血糖监测辅助的肿瘤科医生、药剂师与糖尿病专科医生紧密协作模式，能够有效优化化疗启动期糖尿病患者的整体用药方案并改善血糖控制水平。
肿瘤(癌症)患者之家