Childhood Cancer Survivors at Double the Risk for Diabetes
Elsevier Global Medical News. 2009 Aug 10, MA Moon
oncologystat.com
Young adults who survived childhood cancer, particularly if they underwent abdominal or total body irradiation, are at nearly twice the risk of developing diabetes as their siblings who never had cancer, according to a report in the Aug. 10/24 issue of the Archives of Internal Medicine.
The increased diabetes risk is independent of obesity and physical inactivity. It is most evident among survivors of acute myelogenous leukemia, neuroblastoma, Wilms' tumor, and Hodgkin's lymphoma, especially if they received radiation therapy.
"Indeed, the diabetes observed among this irradiated cancer population may represent a form of therapy-induced diabetes mellitus, and may be the result of an impairment of insulin release and specific beta-cell lesions," according to Dr. Lillian R. Meacham of Emory University, Atlanta, and her associates.
"It is imperative that clinicians recognize this risk, screen for diabetes and prediabetes when appropriate, and approach survivors with aggressive risk-reducing strategies," they noted.
Recent studies have suggested that cancer survivors who underwent bone marrow transplantation are at increased risk for diabetes, particularly those who received total body irradiation (TBI). Abdominal radiation for Wilms' tumor and intracranial radiation also has been linked to obesity, insulin resistance, and diabetes.
To examine the issue, Dr. Meacham and her colleagues assessed subjects in a large, diverse, well-characterized, longitudinal cohort: the Childhood Cancer Survivor Study. They studied 8,599 survivors and 2,936 unaffected siblings who served as a control group (Arch. Intern. Med. 2009;169:1381-8).
The mean age of the survivors was 31 years (range, 17-54 years) at follow-up in 2003, and the mean interval since cancer diagnosis was 23 years. A total of 218 survivors (2.5%) reported taking medication for diabetes, compared with only 49 (1.7%) of the unaffected siblings.
A total of 57% of the survivors who had diabetes were younger than age 35 when they developed the disease. Survivors of acute myelogenous leukemia, neuroblastoma, Wilms' tumor, and Hodgkin??s lymphoma were significantly more likely to develop diabetes than were unaffected siblings.
Survivors who had received abdominal irradiation were nearly three times as likely to develop diabetes, compared with survivors who had not received either therapy, while those treated with TBI were more than seven times as likely, the investigators reported. In contrast, survivors who had been treated with corticosteroids or asparaginase were not at higher risk for diabetes.
Neuroblastoma survivors who were treated with abdominal irradiation had a ninefold higher risk of diabetes than did siblings, after adjustment for body mass index. Neuroblastoma survivors who had not received abdominal irradiation were not at increased risk.
For both Wilms' tumor and Hodgkin's lymphoma survivors, only those treated with irradiation were at increased risk for diabetes.
Abdominal irradiation could lead to diabetes through several possible mechanisms, including beta-cell damage from direct exposure of the pancreas. However, most of the survivors in this study who developed diabetes "were either taking an oral medication or receiving combination therapy, suggesting that, if they have beta-cell dysfunction, it is not absolute. Therefore, there are likely other mechanisms by which abdominal irradiation leads to diabetes," according to Dr. Meacham and her colleagues.
No conflicts of interest were reported for this study. |
