Insulin and glucose homeostasis in childhood cancer survivors treated with abdominal radiation: A pilot study Journal Article

Authors: Friedman, D. N.; Hilden, P.; Moskowitz, C. S.; Wolden, S. L.; Tonorezos, E. S.; Antal, Z.; Carlow, D.; Modak, S.; Cheung, N. K.; Oeffinger, K. C.; Sklar, C. A.
Article Title: Insulin and glucose homeostasis in childhood cancer survivors treated with abdominal radiation: A pilot study
Abstract: Background: Childhood cancer survivors exposed to abdominal radiation (abdRT) are at increased risk for both insulin-dependent and non–insulin-dependent diabetes. We sought to clarify the pathophysiology of diabetes after abdRT by performing dynamic studies of insulin and glucose and testing for type 1 diabetes-associated autoantibodies. Procedure: Cross-sectional analysis of 2-year childhood cancer survivors treated with abdRT at age ≤21 years who underwent oral glucose tolerance testing and assessment of diabetes-related autoantibodies from December 2014 to September 2016. Prevalence of insulin/glucose derangements, indices of insulin sensitivity/secretion (homeostatic model assessment of insulin resistance [HOMA-IR], whole-body insulin sensitivity, insulinogenic index), autoantibody positivity, and treatment/demographic factors associated with adverse metabolic outcomes were assessed. Results: Among 40 participants previously exposed to abdRT (57.5% male; median age at cancer diagnosis, 3.3 years [range, 0.5–20.1]; median age at study 14.3 years [range, 8.3–49.8]; none with obesity), 9 (22.5%) had glucose derangements (n = 4 with impaired fasting glucose [≥100 mg/dL]; n = 4 with impaired glucose tolerance [2-hour glucose 140–199 mg/dL]; n = 1 with previously unrecognized diabetes [2-hour glucose ≥200 mg/dL]). Three of the four individuals with impaired fasting glucose also had insulin resistance, as measured by HOMA-IR; an additional four subjects with normal glucose tolerance were insulin resistant. The subject with diabetes had normal HOMA-IR. No participant had absolute insulinopenia or >1 positive diabetes-related autoantibody. Conclusions: This study suggests that radiation-induced damage to the insulin-producing β-cells is an unlikely explanation for the early derangements in glucose metabolism observed after abdRT. Research into alternative pathways leading to diabetes after abdRT is needed. © 2018 Wiley Periodicals, Inc.
Keywords: radiation; late effects; diabetes; pediatric oncology; endocrinology
Journal Title: Pediatric Blood and Cancer
Volume: 65
Issue: 11
ISSN: 1545-5009
Publisher: Wiley Periodicals, Inc  
Date Published: 2018-11-01
Start Page: e27304
Language: English
DOI: 10.1002/pbc.27304
PROVIDER: scopus
PMCID: PMC6150783
PUBMED: 30009519
Notes: Article -- Export Date: 5 October 2018 -- Source: Scopus
Citation Impact
MSK Authors
  1. Nai-Kong Cheung
    568 Cheung
  2. Charles A Sklar
    311 Sklar
  3. Shakeel Modak
    199 Modak
  4. Suzanne L Wolden
    482 Wolden
  5. Chaya S. Moskowitz
    211 Moskowitz
  6. Patrick Dale Hilden
    106 Hilden
  7. Dean Christian Carlow
    30 Carlow
  8. Zoltan Antal
    8 Antal