High Blood Sugar and Bladder Cancer: What It Means

High blood sugar (hyperglycemia) can matter for people living with bladder cancer. Evidence suggests diabetes and poor glucose control are associated with a higher chance of bladder tumor recurrence and progression, particularly in non–muscle-invasive disease. [PM18] Poor glycemic control has also been linked to increased recurrence risk in related urothelial cancers. [PM20] While individual situations vary, it’s reasonable to consider high blood sugar as a modifiable factor that could affect outcomes. [PM18] [PM21]

Why blood sugar might affect cancer outcomes

• Tumor biology and glucose: Bladder cancer cells often rely heavily on glucose and glycolysis (the “Warburg effect”), and high-glucose conditions can promote aggressive behavior in lab studies. [PM15]
• Diabetes as a risk marker: Diabetes appears to be related to increased bladder cancer incidence and may be associated with cancer-specific mortality in some populations. [PM14]
• Clinical patterns: In real-world cohorts, diabetes has been associated with shorter recurrence-free and progression-free survival in non–muscle-invasive bladder cancer, especially when HbA1c is 7.0% or higher. [PM18]

What the research shows

• Non–muscle-invasive bladder cancer (NMIBC): People with diabetes showed worse recurrence-free and progression-free survival; poor baseline and post-operative glycemic control were tied to higher progression. [PM18]
• Upper urinary tract urothelial carcinoma (related urothelial tumors): Diabetes with poor glycemic control increased the risk of bladder recurrence after nephroureterectomy. [PM20]
• Systematic reviews/meta-analyses: Summaries of prior studies suggest diabetes may negatively impact bladder cancer prognosis, although findings across metabolic syndrome components are mixed and more research is needed. [PM22] [PM17]
• Population cohorts: Some data indicate diabetes and hyperglycemia may increase bladder cancer incidence and bladder cancer–specific death. [PM14]

Treatment considerations and safety

• Chemotherapy and bladder cancer care: Treatment plans for bladder cancer consider tumor stage and grade; chemotherapy is commonly used when disease has spread or in certain perioperative settings. ^[1] High-grade tumors tend to grow and spread more quickly, guiding more aggressive treatment decisions. ^[2]
• Drug-specific hyperglycemia risk: Certain bladder cancer therapies, such as enfortumab vedotin, can themselves cause hyperglycemia or even diabetic ketoacidosis; careful glucose monitoring and optimization are recommended before and during treatment, with holds for high blood sugar. ^[3] Close monitoring is emphasized, especially if baseline HbA1c is above 6.5%. ^[4]
• Care coordination: Cancer treatment can make glucose management harder, and proactive diabetes care can help reduce complications during therapy. ^[5] Optimal blood sugar control supports better overall survivorship and lowers treatment-related risks. ^[6]

Practical steps you can take

• Aim for steady glucose control: Keeping HbA1c in a target range set by your clinician may help reduce the chance of progression and recurrence in NMIBC. [PM18]
• Coordinate with your care team: Let your oncology team and primary care/endocrinology team co-manage your diabetes before starting therapies that may affect blood sugar. ^[4] If you are prescribed treatments known to raise glucose (for example, enfortumab vedotin), follow recommended monitoring and thresholds to pause treatment until levels are safe. ^[3]
• Medication choices: In some studies, metformin did not clearly change bladder cancer recurrence or progression, so it may be used for diabetes control rather than cancer impact alone. [PM18]
• Lifestyle support: Balanced diet, physical activity as tolerated, and consistent medication adherence help maintain glucose control during cancer care. ^[7]

When to be concerned

• Persistent high readings: If fasting glucose is consistently elevated or HbA1c is above target, it may be reasonable to discuss tighter control given the links to worse NMIBC outcomes. [PM18]
• New or worsening hyperglycemia during therapy: Report sudden spikes, symptoms of diabetic ketoacidosis (nausea, vomiting, abdominal pain, confusion, rapid breathing), or readings above thresholds your team sets; some therapies should be held until glucose is safe. ^[3]
• Changes in tumor behavior: Increased recurrence or progression risk has been associated with poor glycemic control; closer cystoscopic surveillance may be appropriate. [PM18]

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Summary

• High blood sugar can be associated with worse bladder cancer outcomes, especially in non–muscle-invasive disease, and better glucose control may be beneficial. [PM18] Diabetes with poor control can increase recurrence risk in related urothelial cancers. [PM20] Some therapies for bladder cancer can raise glucose, so proactive monitoring and coordination are important. ^{[3] [4]} Working with your care team on glucose targets, medications, and lifestyle can help reduce complications during treatment and may improve overall outcomes. ^[6]