Excellent Practices
Specific Diabetic Service for Cancer Patients within Endocrinology
Practice Category: Treatment
Centre: Instituto Português de Oncologia de Coimbra Francisco Gentil E.P.E. (IPO-Coimbra)
Jacinta Santos
Physician (Endocrinologist)
3677@ipocoimbra.min-saude.pt
Challenge addressed by the practice
Cancer patients have a high prevalence of diabetes mellitus and a significant risk of developing treatment-related dysglycaemia, particularly during corticosteroid therapy, immunotherapy, perioperative periods, and other systemic cancer treatments. Poor glycaemic control adversely affects cancer outcomes, increases complication rates, delays treatment delivery, and leads to higher hospitalisation rates. In a tertiary oncology centre, the increasing complexity and volume of patients made it challenging to ensure timely, specialised, and consistent diabetes management across both inpatient and outpatient settings. This resulted in variability in clinical practice, an increased risk of hypo- and hyperglycaemic events, and limited opportunities for professional training, patient education, and systematic quality improvement in diabetology within oncology care.
Solution
A Functional Diabetes Unit was established within the Endocrinology Department to provide structured and specialised diabetes care for oncology patients. The unit coordinates a dedicated Diabetes Clinic, ensures expert assessment in both inpatient and outpatient settings, and supports perioperative and treatment-related diabetes management. Internal referral criteria were established for patients with diabetes mellitus or those at risk of hyperglycaemia, and clinical protocols were developed for the most frequent diabetology-related scenarios. These include, for example, “hypoglycaemia during hospitalisation” and “hyperglycaemia associated with corticosteroid therapy”. The unit promotes continuous professional education for physicians and nurses, provides patient-tailored educational materials, and fosters close collaboration with other clinical services. Telemedicine and digital tools were evaluated to enhance follow-up and accessibility. The unit also contributes to regular reviews of clinical practice and supports continuous professional development through participation in scientific meetings, congresses, and educational workshops, ensuring consistent, high-quality, and evidence-based diabetes care integrated into oncology practice.
Impact
The implementation of the Diabetes Unit improved the organisation and consistency of diabetes care for oncology patients. Clinical practice became more standardised, reducing variability and minimising preventable glycaemic events. Early involvement of endocrinology specialists facilitated improved metabolic control during cancer treatments, perioperative periods, and hospital admissions. Educational initiatives enhanced patients’ understanding of diabetes within the oncological context. Overall, the initiative strengthened the quality of clinical support provided to patients, contributed to safer care delivery, improved clinical outcomes, and reinforced the role of endocrinology within comprehensive cancer care.
Critical success factors
Key success factors included strong institutional support and the designation of responsible clinicians for the Diabetes Unit. A fundamental element was the presence of a dedicated multidisciplinary team, comprising physicians and a specialised nursing team with expertise in diabetes management. Diabetes nurses played a crucial role in the implementation of therapeutic plans, patient education, and glucose monitoring.
The development and implementation of clear clinical protocols for diabetes management in oncology patients ensured consistent and safe practice across care settings. Awareness and educational initiatives, including activities organised for World Diabetes Day, increased professional engagement and patient awareness. Continuous professional training ensured alignment with evolving clinical evidence.
Next steps
Future developments will focus on the progressive integration of advanced diabetes technologies, including continuous glucose monitoring systems and insulin pump therapy, into routine oncology care. Ongoing training and regular updates for healthcare professionals will be prioritised to ensure the safe, effective, and evidence-based use of these technologies. The unit also aims to expand telemonitoring and remote follow-up models, reducing the need for patient travel while ensuring clinical safety and continuity of care. Continuous professional development, supported by institutional commitment and adequate resource allocation, will further enhance the sustainability and effectiveness of the unit.