Prevalence of diabetes mellitus in long-term cancer survivors treated with craniospinal irradiation.
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BACKGROUND: Childhood, adolescent, and young adult cancer survivors (CAYA) are at an increased risk for metabolic disorders such as diabetes mellitus. Although this risk has been well-documented for leukemia survivors and those exposed to abdominal radiotherapy, the metabolic risk profile for brain tumor survivors remains largely unexplored. METHODS: This study assessed the prevalence of diabetes and dysglycemia in 2 CAYA survivor cohorts. The first included medulloblastoma and ependymoma survivors (HIT-MED), with data collected via self-reported online questionnaires. The second (CLI) was a retrospective analysis of an unselected cohort from our late effects clinic. In this cohort, dysglycemia was defined using hemoglobin A1c measurements alone, without additional glucose-based diagnostic criteria. RESULTS: In the HIT-MED group, 37% (197/527) participated in an online-based questionnaire, revealing a diabetes mellitus prevalence of 3.05%. A total of 122 were male and 75 female, mean age was 27.1 ± 4.5 years (range 19-41). In comparison to an age-matched general population, there was no significant difference (P = .468). Among survivors in the CLI group who received craniospinal irradiation (mean age 38 years at assessment), 34.6% (9/26) exhibited dysglycemia, including 7.7% (2/26) with diabetes mellitus and 26.9% (7/26) with prediabetic glucose levels. This represented the second highest prevalence of impaired glucose regulation among all irradiation subgroups. CONCLUSION: CAYA brain tumor survivors exposed to craniospinal radiotherapy have an elevated risk of dysglycemia compared to other survivor cohorts. These findings support the need for structured, risk-adapted long-term metabolic monitoring to enable early intervention and reduce long-term morbidity.