Purpose: To investigate overall characteristics of glucose intolerance in childhood survivors of hematologic diseases and suggest risk factors which increase A1c (glycated hemoglobin) level.
Methods: Based on a retrospective review of 394 children who were diagnosed with acute leukemia or aplastic anemia between 2015 and 2016 under the age of 15, glucose intolerance was observed in 14 patients. A definition of glucose intolerance was A1c above 5.7%. Auxological and biochemical profiles as well as therapeutic factors of the patients were compared.
Results: Among 14 children (3.5%) with glucose intolerance, 7 (50.0%) patients were diagnosed with leukemia and 7 with aplastic anemia; median age at diagnosis was 8.3 years (0.6614.8). 8 patients (57.1%) were diabetic (A1c ≥6.5%, fasting blood glucose ≥126.0 mg/dl and clinical presentation of polyuria, polydipsia or weight loss) whereas 6 (42.9%) were prediabetic (A1c in between 5.7 and 6.4%). Median A1c at diagnosis of glucose intolerance was 6.4% (5.79.4) for leukemia group and 6.6% (5.77.8%) for anemia group. By univariate regression, fasting blood glucose (R2=0.538, P=0.003), glucocorticoid dose (R2=0.920, P<0.001) and volume of transfused red blood cell (R2=0.789, P<0.001) were positively correlated with A1c. Multiple regression analysis suggested accumulated glucocorticoid dose (R2=0.920, P=0.019) as a strong risk factor of glucose intolerance. Using a receiver operating characteristic curve, an optimal cutoff dose of glucocorticoid for the diagnosis of diabetes was 6232.0 mg (area under curve=0.990, P=0.02).
Conclusion: In young survivors after treatment completion of hematologic diseases, several clinical and biochemical factors could influence serum A1c and trigger glucose intolerance. Among them, glucocorticoid dose might be a strong factor which gives rise to newly diagnosed diabetes.
27 - 29 Sep 2018
European Society for Paediatric Endocrinology