The real-life management of glucose homeostasis abnormalities in pediatric onco-hematological diseases: data from a national survey

Abstract

Glycemic abnormalities are a frequent finding in pediatric oncological patients, both during treatment and after its discontinuation. Moreover, impaired glucose tolerance (IGT), impaired fasting glycemia (IFG) and diabetes mellitus (DM) are not rarely diagnosed in non-oncological hematological diseases. To explore the current pediatric Italian approach to the diagnosis and the management of the glycemic alterations in this clinical setting and, thus, to identify and enforce current clinical needs, we submitted an online 23-items survey to all the Italian Associazione Italiana Ematologia Oncologia Pediatrica (AIEOP) centers, and surveys were descriptively analyzed. Thirty-nine AIEOP centers were involved in the study. In 2021, among 75278 children and adolescents affected by an oncological or a hematological disease, 1.2 and 0.65% developed DM, while IGT or IFG were widespread in 2.3 and 2.8%, respectively. The main causes of DM were the use of corticosteroids in patients with cancer and the iron overload in patients with thalassemia. Venous fasting plasma glycemia was the most used tool to detect glycemic abnormalities. The performance of oral glucose tolerance test (OGTT) was extremely limited, except when IFG occurred. Despite the diagnosis of DM, ∼45% of patients with cancer and 30% of patients with one hematological disease did not receive an appropriate treatment. In the other cases, insulin was the drug of first choice. Emerging technologies for diabetes care (glucose sensors and insulin pumps) are not largely used yet. The results of our study support the standardization of the care of the glycemic abnormalities during or after onco-hematologic diseases in the pediatric age. Despite the scarce data in pediatric literature, proper guidelines are needed.

Keywords:

• Cancer
• children
• diabetes mellitus
• impaired fasting glycemia
• impaired glucose tolerance
• thalassemia

Acknowledgments

We thank Angela Mastronuzzi, Cristina Pizzato, Chiara Gorio, Angelica Barone, Ilaria Liguoro, Monica Cellini, Alessandro Cattoni, Laura Battisti, Maddalena Casale, Elena Mastrodicasa, Paola Coccia, Francesco Gigliotti, Tommaso Casini, Federico Verzegnassi, Veronica Maria Folsi, Letizia Pomponia Brescia, Patrizia Bertolini, Cristina Piera Meazza, Giuseppina Aloj, Nicole Santoro, Eulalia Galea, Delia Russo, Arianna Panigari, Fraia Melchionda, Valentina Kiren, Sabrina Zanardi, Francesca Trevisan for their expertise and assistance throughout all the aspect of our study and for their help in completing the survey. We also thank the Associazione Italiana Ematologia Oncologia Pediatrica (AIEOP) for his valuable contribution to the realization of this study.

Ethical approval

Ethics approval was not required for this study.

Author contributions

AZ and PB conceived the study, drafted the initial manuscript, and reviewed and revised the manuscript. MT, NR, EL, GT, FO, GP, LM, MAS, TT, GDA, BP, FR, RM, and VB collected and analyzed data, reviewed and revised the manuscript. AP and SZ coordinated and supervised data collection, and critically reviewed the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.