January 09, 2020
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Survivors of childhood acute lymphoblastic leukemia at higher risk for type 2 diabetes

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Kirsten K. Ness, PT, PhD
Kirsten K. Ness

Survivors of childhood acute lymphoblastic leukemia, particularly those with obesity and/or who received treatment during adolescence, appeared to be at higher risk for type 2 diabetes than the general population, according to study results published in Cancer.

“We had previously noted a higher incidence of metabolic syndrome, including a constellation of problems of hypertension, hypertriglyceridemia, low high-density lipoprotein, elevated fasting glucose and abdominal obesity, in survivors of childhood acute lymphoblastic leukemia,” Kirsten K. Ness, PhD, researcher in the department of epidemiology and cancer control at St. Jude Children’s Research Hospital, told Healio.

“In the general population, metabolic syndrome often preceded diabetes. We wanted to see if the incidence of diabetes was also higher than expected compared with those with no childhood cancer history, and if we could identify survivors at highest risk so they could be closely monitored and counseled to prevent development of diabetes.”

Ness and colleagues sought to assess type 2 diabetes prevalence and risk factors among 1,044 adult survivors of childhood ALL (median age, 33.19 years; interquartile range [IQR], 26.78-40.53; 50.8% male) compared with 368 community controls with no childhood cancer history (median age, 34.48 years; IQR, 28.1-41.72; 45.6% male).

All participants had enrolled in the St. Jude Lifetime Cohort Study between October 2007 and June 2016. Survivors, who had been diagnosed with ALL at least 10 years earlier, and controls, who were frequency matched for age, sex and race, completed clinical and laboratory evaluations.

Survivors appeared more likely than controls to have obesity (BMI 30 kg/m², 45.31% vs. 34.78%) and less likely to be college graduates (32.95% vs. 53.28%).

Results showed 7.47% of survivors had type 2 diabetes, compared with 3.8% of controls (OR = 2.07; 95% CI, 1.11-3.87). Survivors also demonstrated a higher cumulative incidence of type 2 diabetes by age 50 years (16% vs. 9%; P = .01).

Factors associated with type 2 diabetes among survivors included older age (OR = 1.05 for each additional year; 95% CI, 1.02-1.08), BMI greater than or equal to 30 kg/m² (OR = 7.4; 95% CI, 2.61-20.97) and development of drug-induced diabetes during ALL treatment (OR = 4.67; 95% CI, 2.53-8.61), which occurred among 7.85% of survivors.

Limitations of the study included the fact that the results may have been influenced by selection bias due to a participation rate of less than 100%. Researchers also acknowledged that despite a lack of substantial demographic differences between study participants and nonparticipants, survivors who completed on-campus evaluations may have differed with regard to health status compared with nonparticipants.

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“It is important to provide opportunities for both monitoring and lifestyle counseling interventions for these children early. A study evaluating progression of metabolic syndrome, or prediabetes, to diabetes among survivors is underway in our cohort and will provide important additional information,” Ness told Healio. “A diet and exercise intervention to promote weight loss in childhood ALL survivors who are obese is needed.” – by Jennifer Southall

For more information:

Kirsten K. Ness, PhD, can be reached at St. Jude Children’s Research Hospital, 262 Danny Thomas Place, MS735, Memphis, TN 38105; email: kiri.ness@stjude.org.

Disclosures: Grants from the NCI and American Lebanese Syrian Associated Charities supported this study. Ness reports grants from the NCI and other support from American Lebanese Syrian Associated Charities. Please see the study for all other authors’ relevant financial disclosures.