Unmasking a Hidden Burden: Chemotherapy-Induced and Exacerbated Diabetes in Paediatric Cancer: A Report of Two Cases.
This two-case report describes early hyperglycaemia or diabetes during chemotherapy for paediatric ALL and NHL, followed by glycaemic control with insulin in one child and metformin in the other.
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This two-case report describes early hyperglycaemia or diabetes during chemotherapy for paediatric ALL and NHL, followed by glycaemic control with insulin in one child and metformin in the other.
Research significance
The cases provide evidence that glucose abnormalities can be detected soon after corticosteroid- and/or L-asparaginase-containing chemotherapy and managed clinically; they support, but do not establish, the hypothesis that routine low-cost glucose monitoring could enable earlier intervention and reduce severe complications such as DKA in resource-constrained paediatric oncology settings.
Source abstract
UNLABELLED: L-asparaginase and corticosteroids, essential components of paediatric leukaemia and lymphoma treatment, are associated with hyperglycaemia and, rarely, diabetic ketoacidosis (DKA). Chemotherapy-induced diabetes is an under-recognised complication in pediatric oncology in resource-constrained settings. CASE 1: A 4-year-old female with newly diagnosed Acute Lymphoblastic Leukaemia (ALL) was commenced on chemotherapy with prednisolone, 6-mercaptopurine, vincristine, doxorubicin, cyclophosphamide, L-asparaginase and cytarabine. However, on the 7th day of initiating chemotherapy, urinalysis showed glycosuria (+++) and absent ketonuria. Fasting blood glucose (FBG) was 7.4mmol/L. She had generalized boils and poor intravenous (IV) site wound healing. Her body mass index (BMI) was normal. Glycosylated haemoglobin A1c (HbA1c) showed diabetic levels of 7.7%. Serum C-peptide, amylase, and lipase were normal. She was managed with subcutaneous basal and premeal boluses of insulin and monitored by 8-point blood glucose monitoring with good control. Insulin was tapered off when hypoglycaemic episodes set in. She remained normoglycaemic and is being monitored closely. CASE 2: An 11-year-old male was diagnosed with NHL, and chemotherapy was initiated with a regimen consisting of cyclophosphamide, vincristine, oral prednisolone, intrathecal methotrexate, and hydrocortisone. After 8 days on chemotherapy, FBG and RBG were 8.7mmol/L and 9.3mmol/L, respectively. No typical symptoms of DM were noted. Physical examination revealed acanthosis nigricans, BMI of 21.1kg/m2 (overweight), and blood pressure (130/75 mmHg) readings of systolic hypertension and diastolic pre-hypertension. Investigations showed HbA1c of 6.8%, increased serum C-Peptide of 34.39ng/ml (0.78-5.19), confirming insulin resistance. A diagnosis of type 2 DM, possibly exacerbated by steroid therapy, was made. Treatment was commenced with metformin 500mg nocte. The FBG has normalized.These cases demonstrate that early detection of hyperglycaemia during childhood cancer chemotherapy is a low-cost, high-impact intervention that can prevent life-threatening complications such as DKA and its associated morbidity and mortality, especially in resource-constrained settings.