Glucose metabolism abnormalities among pediatric acute lymphoblastic leukemia survivors: Assessment and relation to body mass index and waist to hip ratio

BackgroundAs survival rates of pediatric acute lymphoblastic leukemia (ALL) improve, attention is turning to side and late effects of therapy including glucose metabolism abnormalities.ObjectiveTo asses the presence of abnormal glucose metabolism in pediatric ALL survivors and its possible relation to body mass index (BMI), waist to hip ratio and treatment related factors.Subjects and methodsRetrospective study with a prospective follow-up of 12 ALL survivors who had been off chemotherapy for >9 months was done. Fifteen healthy sex and age matched children were involved as controls. Body mass index (BMI) waist to hip ratio (WHR), and Oral glucose tolerance test (OGTT) were performed with assessment of glycated hemoglobin (Hb A1C) and insulin sensitivity indices.ResultsAt study time the mean BMI, WHR, all components of the OGTT (except the 2 h post load glucose), all indices of insulin sensitivity and the mean Hb A1C% were significantly higher compared to those of the controls. Two survivors (16.6%) developed transient hyperglycemia during therapy, one (8.3%) had pre-diabetes, seven (58.3%) had a risk level of Hb A1C but no one had diabetes mellitus (DM) or insulin resistance (IR). At study time the two survivors with transient hyperglycemia during therapy had a significantly high WHR compared to the remainders. WHR of the survivors at study time correlated significantly with fasting plasma glucose and area of insulin under the curve (AUC). The 2 h post-prandial plasma glucose correlated with the duration after therapy completion.ConclusionsWHR may play a better role than BMI in the prediction of insulin resistance in those patients. Hb A1C may increase earlier than other indices of glucose tolerance.