Background: Diabetes is a recognised long term sequelae in childhood cancer survivors following bone marrow transplantation and total body irradiation (BMT/TBI), due to a combination of insulin deficiency and resistance.
Aim: To characterise presentation, treatment and clinical course of diabetes in childhood leukaemia survivors post BMT/TBI.
Method: A single centre retrospective case note review of diabetes post BMT/TBI identified from departmental database.
Results: 11 cases were identified as having diabetes of 40 BMT/TBI survivors investigated. 6/35 screened by routine OGTT (oral glucose tolerance test) included 4 with raised 120 min postprandial glucose only and 2 with both raised fasting and post prandial glucose; five diabetes cases were identified from referring regional clinicians. One patient presenting with a random glucose of 31.5 mmol/l. Median (range) age of primary diagnosis was 2.6 (0.59.7) years, with TBI at 14.4 (1014.4) Gy in 6 (18) fractions. Two had had additional cranial irradiation and two graft vs host disease. Age of diabetes diagnosis was 15.5 (1126) years, 12.5 (918.2) years post BMT. At presentation 4/7 were asymptomatic, 1/7 unclear from notes, 1/7 complained of fatigue, 1/7 complained of polyuria, polydipsia and weight loss. Median (range) Hba1c was 7.6 (5.212.4) % at presentation. Initial treatment included: basal bolus regime (n=2), once daily detemir (n=1), dietary and lifestyle modifications (n=3) and metformin (n=1). One patient on insulin subsequently had gliclazide and sitagliptine added. One patient initially on basal bolus insulin switched to metformin and gliclazide and discontinued insulin. One patient had improvement of glycaemic control after dietary and lifestyle/exercise interventions with subsequent OGTT demonstrating impaired glucose tolerance. Complications included dyslipidaemia (n=3), microalbuminuria (n=2) and hypertension (n=1).
Conclusion: Childhood leukaemia survivors presenting with diabetes following BMT/TBI can be asymptomatic. There is a variation in the initial choice of management and disease progression, highlighting the need for careful ongoing evaluation and individualised management plans.
10 - 12 Sep 2016
European Society for Paediatric Endocrinology