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Impaired Glucose Tolerance and Insulin Resistance in Survivors of Childhood Acute Lymphoblastic Leukemia: Prevalence and Risk Factors

Surapolchai, Pacharapan MD* †; Hongeng, Suradej MD*; Mahachoklertwattana, Pat MD*; Pakakasama, Samart MD*; Winaichatsak, Angkana MD; Wisanuyothin, Nittaya MD; Pasomsub, Ekawat PhD§; Mahasirimongkol, Surakameth MD; Sirachainan, Nongnuch MD*

Journal of Pediatric Hematology/Oncology: July 2010 - Volume 32 - Issue 5 - p 383-389
doi: 10.1097/MPH.0b013e3181dccc0b
Original Articles

Aim/Purpose Survivors of acute lymphoblastic leukemia (ALL) are at increased risks of impaired glucose metabolism, insulin resistance, and metabolic syndrome. The aim of our study was to determine the prevalence of alterations in glucose metabolism and the predisposing factors of these disturbances in survivors of childhood ALL.

Patients and methods In 131 ALL survivors, an oral glucose tolerance test was conducted to determine β-cell function/insulin sensitivity. The particular risk factors were analyzed and 6 single nucleotide polymorphisms of diabetic predisposing genes: PAX4 and TCF7L2 were genotyped to evaluate the association between these factors and β-cell function/insulin sensitivity.

Results Ten out of 131 survivors (7.6%) had impaired glucose tolerance (IGT) whereas 40 out of 131 (30.5%) had insulin resistance (IR) and showed characteristics of the metabolic syndrome (hyperinsulinemia, hypertriglyceridemia, and low HDL-C). In the logistic regression analysis, the most important factor predicting IGT and IR was older age of survivors (P=0.014 and P<0.001, respectively) whereas the PAX4 R192H mutation (rs2233580) was significantly associated with IGT after adjustment for age (P=0.043) (adjusted OR 5.28, 95% CI 1.06-26.40).

Conclusions Existing evidence suggests that older age is an independent risk factor for developing IGT and IR in childhood ALL survivors, emphasizing the need for life-long metabolic screening. The PAX4 variant might impact individual susceptibility against IGT and diabetes. However, an identification of underlying risk(s) is the rational for future studies.

Departments of *Pediatrics

§Pathology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok

Department of Pediatrics, Faculty of Medicine, Thammasat University, Pathumthani

Maharat Nakhonratchasima Hospital, Nakhonratchasima

Department of Medical Science, National Institute of Health, Ministry of Public Health, Nondhaburi, Thailand

The authors indicated no potential conflicts of interest.

Supported by Ramathibodi Grant for Research Development, Faculty of Medicine Ramathibodi Hospital, Mahidol University; the Thailand Center of Excellence for Life Sciences (TCELS) and the Vejdusit Foundation under the Royal patronage of H.R.H. Princess Galyanivadhana Kromluangnaradhiwasrajanagarindra founded for the underprivileged Thais.

Reprints: Suradej Hongeng, MD, Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand (e-mail:

Received for publication August 6, 2009; accepted February 10, 2010

© 2010 Lippincott Williams & Wilkins, Inc.