Diabetes mellitus in childhood and young adult cancer survivors: A meta-analysis.

Abstract

e24101 Background: Diabetes mellitus (DM) has emerged as a possible late sequela after successfully treating pediatric and young adult (YA) malignancies. We conducted a systematic review and meta-analysis in order to quantify this risk and assess possible risk factors. Methods: We searched MEDLINE and EMBASE databases from inception to April 2019. We included cohort or case-control studies that reported the risk of DM (hazard ratio [HR], relative risk, or odds ratio, and 95% confidence interval [CI]) among childhood and YA cancer survivors ( < age 21 years) compared to those without a history of childhood or YA cancer. We used the Newcastle-Ottawa Score (NOS) to assess risk of bias and study quality. Study effect estimates were pooled using random-effects meta-analyses. Heterogeneity was assessed using the I2 statistic. Results: After applying our exclusion/inclusion criteria, we included 6 articles in our meta-analysis, with a median follow-up time of 11 (range 10-23) years. The median NOS score was 8 (range 7 – 8), indicating high study quality. The risk of DM was significantly higher in childhood and YA cancer survivors relative to controls (HR 1.66, 95% CI 1.54 to 1.79, I2 = 1%). Among cancer types, the highest risk for DM was reported after treatment for leukemia (HR 2.91, 95% CI 2.01 to 4.22 I2 = 75%), lymphoma (HR 1.63, 95% CI 1.37 to 1.94, I2 = 0%) and central nervous system malignancies (HR 1.77, 95% CI 1.30 to 2.39, I2 = 49%), relative to controls. Receiving total body irradiation or abdominal radiation was associated with a DM risk of 4.52 (95% CI 2.29 to 8.93, I2 = 87%), relative to controls. Conclusions: Our meta-analysis demonstrated an increased risk of developing DM among childhood and YA cancer survivors. More emphasis on screening for DM and prevention among this population should be offered.