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.