ESPE Yearbook of Paediatric Endocrinology

sophie.welsch@uclouvain.be Diabet Med. 2022; 39: e14720. PMID: 34652870.

Brief Summary: Childhood cancer survivors are at increased risk of hyperglycaemia and diabetes due to cancer treatments as asparaginase, steroids and total body irradiation. This single center, retrospective study analyzed the prevalence of hyperglycaemia in 267 patients treated between 2004 and 2019 for hematologic malignancies (Acute lymphoblastic leukaemia, ALL, Hodgkin’s lymphoma, HL, and non-Hodgkin’s lymphoma, NHL).

Hyperglycaemia was defined as a random capillary blood or plasma glucose level exceeding 11 mmol/L (200 mg/dl) in at least two different measurements separated by 24 h. All patients received steroid therapy; asparaginase was prescribed to ALL (100%) and NHL patients (33%).

Hyperglycaemia occurred in 18% of ALL patients and 17% of NHL patients, mostly within the first month of treatment, corresponding to pre- and induction phases, and a reduced prevalence during maintenance and remission. The median follow-up duration of blood glucose monitoring was 8.6 months for ALL patients and 3.6 months for NHL patients. At 12 months post ALL treatment, the probability of remaining free of hyperglycaemia was 83.8% and remained relatively unchanged thereafter. Half of ALL patients with hyperglycaemia were treated with insulin and required insulin therapy only during ALL treatment, except one patient who remained insulin-dependent after therapy completion. Obesity/overweight, ongoing puberty at the time of cancer diagnosis, the presence of steroid-resistant disease and the use of HSCT were associated with a higher risk of developing hyperglycaemia in ALL patients.

The study confirms a non-negligible prevalence of hyperglycaemia in patients treated for ALL. Strengths of the study are the large sample size of ALL patients and the evaluation of this possible complication from the start of cancer treatment and not only during remission. Possible limitations are the retrospective design and the small sample size of NHL and HL patients. Furthermore, glucose data in remission phase were unavailable in particular for HL patients. Anthropometric parameters, as waist-to height ratio or waist to hip ratio, considered as indicators of central (visceral) adiposity and metabolic risk in these patients, were not analyzed. Inpatients underwent daily blood tests, which periodically included measurement of plasma glucose levels. Clinical follow-up did not include oral glucose tolerance testing, and this may have led to an underestimation of the proportion of off-therapy patients with impaired glucose tolerance or preclinical diabetes mellitus.