Of the survivors, 218 (2.5 percent) reported having diabetes, while 49 (1.7 percent) of siblings reported having the condition. After adjustment for body mass index, age, sex, race/ethnicity, household income and insurance, the survivors were 1.8 times more likely than the siblings to report diabetes mellitus, with survivors who received total body irradiation, abdominal irradiation and cranial irradiation at increased risk, the authors write. Survivors who were treated with abdominal irradiation were 2.7 times as likely to report diabetes mellitus as those who were not treated with abdominal irradiation or total body irradiation; those treated with total body irradiation were 7.2 times as likely to report diabetes mellitus.

Survivors diagnosed with cancer before age 5 were 2.4 times more likely to report diabetes than those diagnosed in late adolescence (from ages 15 to 20). As in the general population, older age, black or Hispanic/Latino background, lower household income, physical inactivity and increased BMI were associated with an increased risk of diabetes mellitus, they note.

It is likely that this additional chronic disease in childhood cancer survivors, who frequently also sustain damage to the heart, kidneys and endocrine system, will lead to further morbidity and premature mortality, the authors conclude. Therefore, it is imperative that clinicians recognize this risk, screen for diabetes and prediabetes when appropriate and approach survivors with aggressive risk-reducing strategies. Moreover, further research is warranted to understand the pathways by which these two modes of radiation therapy lead to diabetes.(Arch Intern Med. 2009;169[15]:1381-1388.

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