Glycemic variability
There was a median of 37 glucose measurements from day -14 to day 30 per subject (IQR 32-40), with a median of 8 pre-HSCT (IQR 8-8), and 30 in days 0-30 (IQR 24-31). The median glucose CV was 17.8% (IQR 11.2-24.4%) pre-HSCT and 15.5% (IQR 11.6-24.2%) post-HSCT. While no normal glucose CV ranges have been described in pediatric patients, 38% of patients pre-HSCT and 33% of patients in day 0-30 had a CV above the reported healthy adult range (Table S2).8 Figure 1 demonstrates CV distributions by time interval and glucose CV grade.
Table 3 demonstrates multivariable models to assess for risk factors associated with glucose CV. Prior asparaginase exposure and non-malignant diagnosis were associated with higher pre-HSCT CV, whereas post-HSCT glucose CV was increased with pre-HSCT radiation to the pancreas (excluding total body irradiation [TBI]), prior insulin therapy, allogeneic HSCT, day 0-30 steroid exposure, and post-HSCT TPN. Overweight BMI was associated with decreased glucose post-HSCT CV. Additionally, among patients who underwent allogeneic transplant, GVHD prophylaxis with tacrolimus was associated with increased glucose CV after adjusting for exposure to other immunosuppressive agents.