Prevalence and Risk Factors Of Insulin Resistance and Impaired Fasting Glucose and Obesity among Pediatric Acute Lymphoblastic Leukemia Survivors in India

Nirmal G, Thankamony P, Guruprasad CS, Nair M, Rajeswari B, Shwetha S, Jagathnath Krishna KM and Pillai RK

Published on: 2023-10-24

Abstract

Background: This prospective study aimed to estimate the prevalence of Insulin Resistance (IR) and Impaired Fasting glucose (Prediabetes/ Diabetes) and obesity among childhood Acute Lymphoblastic Leukemia (ALL) survivors

Methods: Children diagnosed with ALL at ≤ 14 years and on follow up for >2 years after treatment completion at RCC in South India were enrolled between 1st April 2018 and 31st March 2019. Insulin resistance (IR) was assessed by Homeostasis model assessment (HOMA-IR).  To classify overweight/ obesity, a BMI WHO z score of ≥1.03 was used in childhood survivors ≤ 19 years old while adult cut off of BMI value ≥ 25 Kg/m² was used for survivors > 19 years old.

Results: Two hundred and two ALL survivors with a median age of 13.2± 3.8 years were evaluated. Forty one (21%) survivors were overweight/obese. The overall prevalence of IR was 31.2% (n=63) and Prediabetes was 8.4 % (n=17) in the survivor population. None of the survivors had Diabetes Mellitus. Female survivors were more likely to have hyperinsulinemia (p-value:0.043) while male survivors were more likely to have prediabetes. Insulin resistant survivors received higher cumulative dose of steroids and higher cumulative dose of L-Asparaginase as compared to Insulin sensitive survivors. Puberty had no impact on HOMA IR in boys and girls. On multivariate analysis, only older age at enrolment (OR=1.012, 95% CI: 1.004- 1.019; p- value=0.002) and overweight or obesity at survivor enrolment (OR=4.985, 95% CI: 2.319- 10.718; p-value=0.001) were significant predictors of IR in pediatric ALL survivors.

Conclusion: Prevalence of insulin resistance (31.2%), prediabetes (8.4%) and obesity (12.8%) were high in Indian survivors of childhood ALL. Older age and overweight/ obesity at survivor enrolment were significant predictors of IR. Although no survivor was diabetic at present, 8.4% of were prediabetic, suggesting that this outcome will become more prevalent as survivors ages & requires monitoring