Diabetes Mellitus Prevalence and Risk Factors in Dutch Childhood Cancer Survivors
Overview
This study assessed diabetes mellitus (DM) prevalence in 2338 long-term childhood cancer survivors (CCS) in the Netherlands, revealing a threefold increased risk compared to the general population. Key determinants included age, BMI, family history, prior radiotherapy, hypogonadism, hypertension, and dyslipidemia.
Background
Childhood cancer survival rates have improved significantly, but survivors face increased lifelong risks of chronic conditions, including endocrine disorders like diabetes mellitus. DM in CCS is associated with higher risks of cardiovascular disease and early mortality. Understanding DM prevalence and risk factors in CCS is crucial for targeted screening and preventive interventions. Previous studies often underestimated DM risk due to reliance on self-report or incomplete data.
Data Highlights
Measure
Adjusted Odds Ratio (aOR)
95% Confidence Interval
Hyperglycemia (fasting glucose ≥7.0 mmol/L or nonfasting ≥11.1 mmol/L)
2.72
2.06-3.59
Previous DM diagnosis
3.03
2.33-3.95
Antidiabetic medication use
2.94
2.17-3.99
Age >35 years vs 18-35 years
4.32
1.84-10.15
BMI (per point increase)
1.12
1.08-1.16
Family history of DM
2.38
1.51-3.76
Abdominal/pelvic radiotherapy
4.19
2.32-7.55
Total body irradiation
14.31
6.98-29.34
Hypogonadism
2.40
1.15-4.99
Hypertension
1.71
1.06-2.76
Dyslipidemia
3.81
2.15-6.75
Key Findings
Childhood cancer survivors had a threefold increased risk of diabetes mellitus compared to a large adult reference cohort.
Older age (>35 years) and higher BMI were significant demographic risk factors for DM in CCS.
Prior abdominal/pelvic radiotherapy and especially total body irradiation were strongly associated with increased DM risk.
Endocrine comorbidities such as hypogonadism, hypertension, and dyslipidemia were independently linked to DM development.
A significant interaction between age and sex influenced DM risk in survivors.
Family history of diabetes was an important determinant of DM in CCS.
Clinical Implications
These findings highlight the necessity for early, risk-based diabetes screening in childhood cancer survivors, particularly those exposed to abdominal or total body irradiation and those with modifiable risk factors like elevated BMI. Lifestyle interventions targeting weight management and cardiovascular risk factors may be beneficial in reducing DM incidence and its associated morbidity in this high-risk population.
Conclusion
Childhood cancer survivors in the Netherlands exhibit a substantially increased prevalence of diabetes mellitus, influenced by treatment exposures and metabolic comorbidities. Tailored surveillance and preventive strategies are essential to mitigate long-term DM-related health consequences in this vulnerable group.
References
DCCS-LATER2 Study Group 2023 -- Assessment of Diabetes Mellitus Prevalence and Influencing Factors in 2338 Long-Term Survivors of Childhood Cancer in the Netherlands
by Melissa Bolier, Demi T C de Winter, Marta Fiocco, Sjoerd A A van den Berg, Dorine Bresters, Eline van Dulmen-den Broeder, Margriet van der Heiden-van der Loo, Imo Hoefer, Geert O Janssens, Leontien C M Kremer, Jacqueline J Loonen, Marloes Louwerens, Heleen J van der Pal, Saskia M F Pluijm, Wim J E Tissing, Hanneke M van Santen, Andrica C H de Vries, Aart-Jan van der Lely, Marry M van den Heuvel-Eibrink, Sebastian J C M M Neggers
