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Survivors of childhood leukaemia treated with haematopoietic stem cell transplantation and total body irradiation should undergo screening for diabetes by oral glucose tolerance tests
Author(s) -
Wei C.,
Unsworth R.,
Davis N.,
Cox R.,
Bradley K.,
Stevens M.,
Crowne E.
Publication year - 2016
Publication title -
diabetic medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.474
H-Index - 145
eISSN - 1464-5491
pISSN - 0742-3071
DOI - 10.1111/dme.13060
Subject(s) - medicine , total body irradiation , diabetes mellitus , haematopoiesis , transplantation , stem cell , endocrinology , chemotherapy , genetics , cyclophosphamide , biology
Aims Childhood cancer survivors treated with haematopoietic stem cell transplantation ( HSCT ) and total body irradiation are at an increased risk of developing diabetes early in life due to insulin resistance and β–cell dysfunction, but the optimal screening method is unknown. The National Institute for Health and Care Excellence guidelines for community diabetes screening recommend using fasting glucose ≥ 7 mmol/l and/or HbA 1c ≥ 48 mmol/mol (6.5%) for diagnosis and, fasting glucose 5.5–6.9 mmol/l or HbA 1c 42–47 mmol/mol (6–6.5%) to indicate high risk. This study aimed to evaluate the sensitivities of fasting glucose and HbA 1c in the diagnosis of diabetes and impaired glucose tolerance in childhood HSCT survivors. Method The patients were 35 (male = 19) HSCT survivors from a single UK centre under follow‐up from 2006 to 2013. Patients had a median age (range) of 19.2 (13.1–26.2) years and had been treated for acute lymphoblastic ( n = 31) or myeloid ( n = 4) leukaemia when aged 7.8 (2.4–16.7) years. The outcome measures were oral glucose tolerance test ( OGTT ), fasting glucose and HbA 1c . Results OGTT identified 6 patients with diabetes (120‐min glucose ≥ 11.1 mmol/l), 12 with impaired glucose tolerance (120–min glucose 7.8–11.0 mmol/l) and 2 with impaired fasting glucose (≥ 7 mmol/l). Fasting glucose ≥ 7 mmol/l or HbA 1c ≥ 48 mmol/mol identified two of the six patients with diabetes diagnosed on OGTT . Fasting glucose ≥ 5.5 mmol/l and HbA 1c ≥ 42 mmol/mol identified three and two patients, respectively, with diabetes. Only 1 of 12 patients with impaired glucose tolerance had a fasting glucose ≥ 5.5 mmol/l and none had HbA 1c ≥ 42 mmol/mol (≥ 6%). Conclusions The fasting glucose and HbA 1c cut‐offs used in UK population screening only identified one‐third of HSCT survivors with diabetes and do not identify those at risk. Diabetes screening in HSCT survivors requires standard OGTT s.