Clinical Scorecard: Assessment of Diabetes Mellitus Prevalence and Influencing Factors in 2338 Long-Term Survivors of Childhood Cancer in the Netherlands (DCCS-LATER2 Study)
At a Glance
Category
Detail
Condition
Diabetes Mellitus (DM) as a late effect in childhood cancer survivors
Key Mechanisms
Increased risk linked to prior cancer treatments (abdominal/pelvic radiotherapy, total body irradiation), endocrine comorbidities, and lifestyle factors
Target Population
Adult survivors of childhood cancer treated between 1963 and 2002 in the Netherlands
Care Setting
Late-effects clinics and risk-based screening programs for childhood cancer survivors
Key Highlights
Childhood cancer survivors have a 3-fold increased risk of diabetes mellitus compared to the general population.
Significant determinants of DM include age >35 years, higher BMI, family history of DM, prior abdominal/pelvic radiotherapy, total body irradiation, hypogonadism, hypertension, and dyslipidemia.
Early risk-based screening and lifestyle interventions are critical to reduce DM and cardiovascular disease risk in this high-risk population.
Guideline-Based Recommendations
Diagnosis
Use serum glucose measurements (fasting glucose ≥7.0 mmol/L or nonfasting ≥11.1 mmol/L) and/or self-report of previous diagnosis or antidiabetic medication use to identify DM in survivors.
Management
Implement early risk-based screening for DM in childhood cancer survivors, especially those with identified risk factors.
Explore lifestyle interventions such as healthy diet, weight loss, and physical activity to delay or prevent DM development.
Monitoring & Follow-up
Regular monitoring of glucose levels and cardiovascular risk factors in survivors, particularly those with prior abdominal/pelvic radiotherapy or total body irradiation.
Assess and manage comorbid conditions like hypogonadism, hypertension, and dyslipidemia to mitigate DM risk.
Risks
Childhood cancer treatments including abdominal/pelvic radiotherapy and total body irradiation significantly increase DM risk.
Endocrine disorders and metabolic comorbidities contribute to higher DM prevalence and associated cardiovascular morbidity.
Patient & Prescribing Data
Adult childhood cancer survivors with a median age of 34.7 years and median follow-up of 27.1 years.
Antidiabetic medication use is nearly three times higher in survivors compared to the general population, reflecting increased DM prevalence.
Clinical Best Practices
Incorporate comprehensive glucose screening including biochemical testing and self-report in survivor follow-up.
Identify and address modifiable risk factors such as BMI and lifestyle to reduce DM incidence.
Tailor surveillance guidelines based on individual risk profiles including treatment history and endocrine status.
Promote multidisciplinary care involving endocrinology, oncology, and primary care to optimize long-term outcomes.
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
Researchers found that patients with higher waist circumference and lower grip strength had the greatest risk for developing type 2 diabetes during long-term follow-up.
