TY - JOUR
T1 - Prevalence and determinants of diabetes mellitus in 2,338 long-term Dutch childhood cancer survivors (DCCS-LATER2 Study)
AU - Bolier, Melissa
AU - de Winter, Demi T C
AU - Fiocco, Marta
AU - van den Berg, Sjoerd A A
AU - Bresters, Dorine
AU - van Dulmen-den Broeder, Eline
AU - van der Heiden-van der Loo, Margriet
AU - Hoefer, Imo
AU - Janssens, Geert O
AU - Kremer, Leontien C M
AU - Loonen, Jacqueline J
AU - Louwerens, Marloes
AU - van der Pal, Heleen J
AU - Pluijm, Saskia M F
AU - Tissing, Wim J E
AU - van Santen, Hanneke M
AU - de Vries, Andrica C H
AU - van der Lely, Aart-Jan
AU - van den Heuvel-Eibrink, Marry M
AU - Neggers, Sebastian J C M M
N1 - Publisher Copyright:
© The Author(s) 2025. Published by Oxford University Press on behalf of the Endocrine Society.
PY - 2025/10
Y1 - 2025/10
N2 - 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.
AB - 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.
KW - childhood cancer survivor
KW - diabetes mellitus
KW - late effect
KW - risk factor
UR - https://www.scopus.com/pages/publications/105016739631
U2 - 10.1210/clinem/dgaf078
DO - 10.1210/clinem/dgaf078
M3 - Article
C2 - 39916355
SN - 0021-972X
VL - 110
SP - e3259–e3270
JO - The Journal of clinical endocrinology and metabolism
JF - The Journal of clinical endocrinology and metabolism
IS - 10
ER -