Introduction
Current survival outcomes of pediatric acute lymphoblastic leukemia
(ALL) approaches 90% in high income countries(1). Improved survival in
childhood ALL results from a fine balance between the utilization of
intensified chemotherapy protocols and rigorous supportive measures to
address complications arising during therapy(2). Drug induced diabetes
mellitus (DIDM) is a common complication during ALL treatment and the
reported prevalence of which varies between 9.7% to 69% in
literature(3). Older age (Age>10years), obesity (BMI≥+2),
Trisomy 21, high risk ALL group are well known risk factors for the
occurrence of DIDM in ALL. Complications of DIDM during ALL therapy
include diabetic keto-acidosis, higher risk for infections, including
cellulitis, bacteraemia, fungaemia and a higher incidence of febrile
neutropenia(4). The impact of hyperglycaemia on overall outcomes in ALL
is mixed. Analysis of four consecutive pediatric ALL clinical protocols
(1991 to 2007) from St. Jude’s children research hospital found no
significant difference in clinical remission rates, event free/overall
survival, cumulative incidence of relapse and probability or types of
infection between patients who did and did not experience
hyperglycaemia(5). However, a recent study from North America noticed
that, patients developing DIDM during induction chemotherapy were more
likely to require admission to intensive care unit and increased
mortality. These patients are also more likely to have subsequent
serious infections, greater length of hospital stay, disease relapse,
transplant need and higher cost of care(6). Majority of the evidences
for management of DIDM during ALL therapy arises out of retrospective
studies and there are no clear-cut guidelines for the diagnosis and
treatment of DIDM during ALL treatment(7). The purpose of this review is
to provide a constructed approach for diagnosis and management of DIDM
in paediatric ALL.