Background: Patients who have received an hematopoietic stem cell transplantation (HSCT) have more risk of endocrine complications (hypothyroidism, hypogonadism, and growth retardation) but the incidence of diabetes after HSCT is not as well known. The pathogenesis of the diabetes is not well established, and is believed to be multifactorial: chemotherapy, pancreatic irradiation, inflammatory cascade and cytokines, steroids and predisposing genetic factors.
Objective and hypotheses: Describe the incidence of DM after HSCT.
Method: Retrospective analysis of 14 patients who received HSCT and who have developed diabetes following ADAs criteria in the last 2 years (20112013).
Results: 16% of patients who received HSCT developed diabetes. Eight patients were women (57%). Mean age at HSCT: 13.2 years (718 years). Two had family history of DM2 (14.3%). Anthropometric data at HSCT: normal weight. Three patients were prepuberal. Indication for HSCT: acute lymphoblastic leukemia (5), acute yelogenous leukemia (3), acquired aplastic anemia (3), thalassemia major (1), Fanconi anemia (1), and lymphoma (1). 6 (45%) received an HLA identical HSCT of bone marrow and 8 (55%) unrelated donor (six bone marrow and two cord blood). Maximum dose of corticosteroids before diabetes diagnosis: 1.6 mg/kg per day. Diagnosis of hyperglycemia without ketosis after HSCT: 166.5 days (range 15902 days). Average glycemia: 329 mg/dl, HbAc1: 7.2% (NV: 4.76.4%), C peptide: 3.2 ng/ml (NV 0.813.85 ng/ml), and insulinemia 24.3 mU/l. Study of antibodies prior to insulin therapy was performed in eight patients remain positive in one case for antiGAD65. Treatment: MDI with basal-bolus, short acting insulin and basal insulin (glargine (71%) and detemir (29%)). If insulin dose was>1.5 U/kg per day, metformin (35.7%, five patients) was added. Comorbidities: 100% arterial hypertension and hypertriglyceridemia.
Conclusion: Diabetes after HSCT is associated with metabolic syndrome with insulin resistance, dyslipidemia, and hypertension associated relative insulinopenia. Some patients benefit from coadyuvance with metformin. Diabetes must be considered in patients who have undergone HSCT. Periodic screening with basal glucose is recommended.
20 - 22 Sep 2014
European Society for Paediatric Endocrinology