Key result
Childhood cancer survival is linked to ~203% higher odds of diabetes versus no cancer history.
Why the study?
Diabetes mellitus is a possible adverse effect of childhood cancer treatment associated with cardiovascular disease and early mortality, but its prevalence and determinants in nationwide childhood cancer survivors needed assessment.
What is the prevalence and what are the determinants of diabetes mellitus in long-term childhood cancer survivors compared to the general population?
Cross-Sectional (n=2,338)
Yes
What is the prevalence and what are the determinants of diabetes mellitus in long-term childhood cancer survivors compared to the general population?
Effect estimate: aOR 3.03 (95% CI 2.33-3.95)
Long-term childhood cancer survivors have a 3-fold increased risk of developing diabetes mellitus compared to the general population, highlighting the need for early screening.
May support targeted diabetes screening in survivors; leaves open prospective validation before practice change.
CONTEXT: Diabetes mellitus (DM), a possible adverse effect of childhood cancer treatment, is strongly associated with cardiovascular disease and early mortality in adult childhood cancer survivors (CCS). OBJECTIVE: Here, we assess the prevalence and determinants of DM in our nationwide CCS cohort. METHODS: In this cross-sectional study, the prevalence of DM was assessed in 2338 CCS, using the Lifelines cohort (n = 132 226 adults with no history of cancer) as a reference. DM was defined through serum glucose measurement (fasting glucose ≥7.0 mmol/L or nonfasting ≥11.1 mmol/L) and/or self-report (previous diagnosis and/or medication use). Multivariable logistic regression models, adjusted for age, sex, and body mass index (BMI), were used to assess the cohort effect on the presence of DM. Multivariable logistic regression analysis was used to identify determinants of DM in CCS. RESULTS: Survivors (median age 34.7 years, median follow-up time 27.1 years) showed increased odds for hyperglycemia (aOR = 2.72; 95% CI, 2.06-3.59), previous DM diagnosis (aOR = 3.03; 95% CI, 2.33-3.95), and antidiabetic medication use (aOR = 2.94; 95% CI, 2.17-3.99), compared to the reference cohort. Age (OR = 4.32; 95% CI, 1.84-10.15, >35 vs 18-35 years), BMI (OR = 1.12; 95% CI, 1.08-1.16, per point), family history of DM (OR = 2.38; 95% CI, 1.51-3.76), prior abdominal/pelvic radiotherapy (OR = 4.19; 95% CI, 2.32-7.55), total body irradiation (OR = 14.31; 95% CI, 6.98-29.34), hypogonadism (OR = 2.40; 95% CI, 1.15-4.99), hypertension (OR = 1.71; 95% CI, 1.06-2.76), and dyslipidemia (OR = 3.81; 95% CI, 2.15-6.75) were associated with DM in CCS. A statistically significant interaction between age and sex on the development of DM in survivors was identified. CONCLUSION: The identified 3-fold increased risk of DM in CCS, along with the clinically relevant and some modifiable determinants, underscores the importance of early risk-based screening and the exploration of lifestyle interventions in this population.
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Bolier et al. (2025) conducted a cross-sectional in Childhood cancer survivors (n=2,338). Childhood cancer survivorship vs. Adults with no history of cancer (Lifelines cohort) was evaluated on Previous diabetes mellitus diagnosis (aOR 3.03, 95% CI 2.33-3.95). Childhood cancer survivors had significantly increased odds of a previous diabetes mellitus diagnosis compared to adults with no history of cancer (aOR 3.03; 95% CI 2.33-3.95).
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