In a study reported in the Journal of Clinical Oncology, Dixon et al found that adult survivors of childhood cancers with prediabetes were at an increased risk of developing cardiovascular events and chronic kidney disease.
The study involved data from 3,529 ≥ 5-year survivors of childhood cancer from the St. Jude Lifetime Cohort and 448 controls matched for age. Prediabetes was defined as a fasting plasma glucose of 100 to 125 mg/dL or a hemoglobin A1c of 5.7% to 6.4%.
Key Findings
Among survivors, median age was 30 years (interquartile range = 18–65 years). The prevalence of prediabetes was 29.2% (95% confidence interval [CI] = 27.7%–30.7%) among survivors vs 18.1% (95% CI = 14.5%–21.6%) among controls. The prevalence of diabetes was 6.5% (95% CI = 5.7%–7.3%) vs 4.7% (95% CI = 2.7%–6.6%). By age 40 to 49 years, 45.5% of survivors vs 26.5% of controls had prediabetes, and 14.0% vs 11.2% had diabetes, respectively.
Among 695 survivors with follow-up data, 68 (10%) progressed to diabetes with a median follow-up of 5.1 years. In analysis adjusted for demographic factors and body composition variables, increased risk of progression to diabetes was associated with radiation exposure to the pancreatic tail of ≥ 10 Gy (hazard ratio [HR] = 2.7, 95% CI = 1.1–6.8) and total-body irradiation (HR = 4.4, 95% CI = 1.5–3.1).
In analysis adjusting for treatment exposures, survivors with prediabetes were at an increased of subsequent myocardial infarction (HR = 2.4, 95% CI = 1.2–4.8) and chronic kidney disease (HR = 2.9, 95% CI = 1.04–8.15) vs survivors with normal glucose control. Those with diabetes were at an increased risk of cardiomyopathy (HR = 3.8, 95% CI = 1.4–0.5) and stroke (HR = 3.4, 95% CI = 1.3–8.9).
The investigators concluded, “Prediabetes is highly prevalent in adult survivors of childhood cancer and [is] independently associated with an increased risk of future cardiovascular and kidney complications. Prediabetes, a modifiable risk factor among childhood cancer survivors, represents a new target for intervention that may prevent subsequent morbidity and mortality.”
Stephanie B. Dixon, MD, MPH, of the Department of Oncology, St. Jude Children’s Research Hospital, Memphis, is the corresponding author for the Journal of Clinical Oncology article.
Disclosure: The study was supported by the National Cancer Institute, St. Baldrick’s Foundation, and the American Lebanese-Syrian Associated Charities. For full disclosures of the study authors, visit ascopubs.org.
