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Can Dexamethasone Cause Hyperglycemia in Myeloma?
Can dexamethasone cause hyperglycemia in myeloma patients undergoing induction therapy? Yes, according to the research linked below. Dex. can cause diabetic ketoacidosis.
I am a long-term MM survivor. I have learned several issues over the years that may help put this issue in perspective.
- First, just because a given therapy is prescribed to you by your oncologist, it doesn’t mean that the given therapy cannot cause serious side effects
- Second, as the second study linked below documents, dexamethasone dose reductions did not influence PFS or OS survival in newly diagnosed MM patients undergoing induction therapy.
Dexamethasone & Diabetes
Email me at David.PeopleBeatingCancer@gmail.com with questions about your short-term, long-term, and late-stage side effects caused by chemotherapy and radiation.
Hang in there,
David Emerson
- MM Survivor
- MM Cancer Coach
- Director PeopleBeatingCancer
Glucocorticoid-Induced Hyperglycemia: A Neglected Problem 
Glucocorticoids provide a potent therapeutic response and are widely used to treat a variety of diseases, including coronavirus disease 2019 (COVID-19) infection. However, the issue of glucocorticoid-induced hyperglycemia (GIH), which is observed in over one-third of patients treated with glucocorticoids, is often neglected.
To improve the clinical course and prognosis of diseases that necessitate glucocorticoid therapy, proper management of GIH is essential. The key pathophysiology of GIH includes systemic insulin resistance, which exacerbates hepatic steatosis and visceral obesity, as well as proteolysis and lipolysis of muscle and adipose tissue, coupled with β-cell dysfunction.
For patients on glucocorticoid therapy, risk stratification should be conducted through a detailed baseline evaluation, and frequent glucose monitoring is recommended to detect the onset of GIH, particularly in high-risk individuals. Patients with confirmed GIH who require treatment should follow an insulin-centered regimen that varies depending on whether they are inpatients or outpatients, as well as the type and dosage of glucocorticoid used.
The ideal strategy to maintain normoglycemia while preventing hypoglycemia is to combine basal-bolus insulin and correction doses with a continuous glucose monitoring system…
CONCLUSIONS
Glucocorticoids offer potent therapeutic benefits and have seen increased use during the COVID-19 pandemic. However, GIH demands greater attention in clinical practice, as it remains a neglected problem. Collaborative efforts among experts in diverse fields are crucial to gather high-quality evidence regarding the pathophysiology of GIH, as well as to refine patient evaluation, diagnosis, and management strategies.
Furthermore, it is essential to prevent complications associated with GIH and improve patient outcomes by identifying novel therapeutic targets or achieving consensus on optimal management practices beyond current standards.”
Dexamethasone dose intensity does not impact outcomes in newly diagnosed multiple myeloma: a secondary SWOG analysis
“Key Points
- Dexamethasone dose reductions <40 to 60 mg weekly are common in multiple myeloma, even for patients enrolled on clinical trials.
- In our large analysis of 2 clinical trials, dexamethasone dose reductions did not impact PFS or OS.
Dexamethasone is a key component of induction for newly diagnosed multiple myeloma (NDMM), despite common toxicities, including hyperglycemia and insomnia. In the randomized ECOG E4A03 trial, dexamethasone 40 mg once weekly was associated with lower mortality than higher doses.
However, the performance of dexamethasone dose reductions below this threshold concerning progression-free survival (PFS) and overall survival (OS) in NDMM has not been fully characterized.
We conducted a secondary pooled analysis of the SWOG 0777 and SWOG 1211 studies of NDMM, which used lenalidomide and dexamethasone (Rd) alone, with or without bortezomib, and with or without elotuzumab. The planned dexamethasone intensity was 40 to 60 mg weekly in all arms.
Patients were categorized into FD-DEX (full-dose dexamethasone maintained throughout induction) or LD-DEX (lowered-dose dexamethasone or discontinuation; only permitted for grade 3+ toxicities per both study protocols). Of the 541 evaluated patients, the LD-DEX group comprised 373 patients (69%).
There were no differences in PFS or OS between the FD-DEX and LD-DEX groups, which were balanced in terms of age, stage, and performance status. Predictors of PFS and OS in the multivariate models were treatment arm, age ≥70 years, and thrombocytopenia. FD-DEX did not significantly improve either outcome.
Our study suggests that dexamethasone dose reductions are common in multiple myeloma, even within clinical trials.
Given the many toxicities and unclear benefits of dexamethasone in the era of modern treatment regimens, dexamethasone dose reduction during NDMM induction warrants further prospective studies. These trials were registered at www.clinicaltrials.gov as #NCT00644228 and NCT01668719…”
can dexamethasone cause hyperglycemia in myeloma