AIMS
Diabetes mellitus (DM), a possible late effect in adult childhood cancer survivors (CCS), is strongly associated with cardiovascular disease and early mortality. Here, we assess the prevalence and determinants of DM in our nationwide CCS cohort.
METHODS
In this cross-sectional study (part of the Dutch Childhood Cancer Survivorship Study 2), the prevalence of DM was assessed in 2,338 CCS (treated 1963-2002, recruited 2016-2020), using the Lifelines cohort (n=132,226 adults with no history of cancer) as a reference. DM was defined through serum glucose measurement (fasting serum glucose value ≥7.0mmol/L or non-fasting ≥11.1mmol/L) and/or self-report (previous diagnosis and/or medication use). Multivariable logistic regression models, adjusted for age, sex, and BMI, were used to assess the cohort effect on the presence of DM. Multivariable logistic regression analysis was used to identify demographic-, lifestyle-, treatment- and endocrine comorbidity-related determinants of DM in CCS.
RESULTS
Survivors (51.2% male, median age 34.7 years (range 18.2-70.8), median follow-up time 27.1 years (range 14.8-54.7)) showed increased odds of hyperglycemia (aOR=2.72, 95%CI=2.06-3.59), DM diagnosis (adjusted odds ratio (aOR)=3.03, 95%CI=2.33-3.95), and anti-diabetic medication use (aOR=2.94, 95%CI=2.17-3.99), compared to the reference cohort (41.4% male, median age 43.0 years). Age (OR=4.26, 95%CI=1.81-10.05, >35 versus 18-35 years), BMI (OR=1.11, 95%CI=1.07-1.16, per point), family history of DM (OR=2.59, 95%CI=1.63-4.11), prior abdominal/pelvic radiotherapy (OR=4.14, 95%CI=2.29-7.49), total body irradiation (OR=13.60, 95%CI=6.48-28.51), hypogonadism (OR=2.21, 95%CI=1.04-4.70), and dyslipidemia (OR=3.79, 95%CI=2.13-6.74) were associated with DM in CCS. A significant interaction between age and sex on the development of DM in survivors was identified.
CONCLUSIONS
The increased risk of DM in CCS, along with the identified clinically relevant, and some modifiable, determinants, underscores the importance of early risk-based screening as well as the exploration of lifestyle interventions to possibly prevent subsequent morbidity and mortality in this high risk population.