title: Risk Factors for Hyperglycemia During Chemotherapy for Acute Lymphoblastic Leukemia Among Taiwanese Children.
abstract: BACKGROUND
  Hyperglycemia is common during treatment for pediatric acute lymphoblastic leukemia (ALL). Several risk factors have been proposed, but emergence of new evidence suggests conflicting results. In view of ethnic differences in the propensity for diabetes, this study aims to delineate the characteristics of pediatric patients at risk for hyperglycemia during chemotherapy in Taiwan.
  
  
  METHODS
  This retrospective study involved chart review of consecutive patients younger than 18 years with diagnosis of ALL in a medical center in Taiwan from 1997 to 2008. Hyperglycemia was defined by random plasma glucose levels ≥200 mg/dL or fasting glucose levels ≥126 mg/dL in at least two separate samplings. Risk factors for hyperglycemia were described with crude and adjusted odds ratios (OR) with 95% confidence intervals (CI) in the univariate and multivariate regression analysis.
  
  
  RESULTS
  A total of 133 patients were included for analysis. Overall, 22 patients (16.5%) experienced hyperglycemia during ALL treatment. Most hyperglycemic episodes occurred within the first 8 days after prednisolone use. Age older than 10 years was the most important predictor of hyperglycemia (adjusted OR = 10.88, 95% CI 2.40-49.37). Patients with fasting glucose concentration ≥100 mg/dL were also 5.7-fold (95% CI 1.63-19.93) more likely to develop hyperglycemia, whereas the predictive significance of obesity was attenuated after adjustment.
  
  
  CONCLUSIONS
  Assessment of glucose concentration should be vigilant in the 1(st) week after prednisolone use during ALL treatment. Clinicians should be alert to the patient at risk of hyperglycemia, particularly obese adolescents with disarranged glucose homeostasis.
authors: Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
authors: Meng-Che
authors: MC
authors: Tsai
authors: Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
authors: Hsin-Hui
authors: HH
authors: Huang
authors: Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
authors: Yen-Yin
authors: YY
authors: Chou
authors: Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
authors: Chao-Neng
authors: CN
authors: Cheng
authors: Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan. Electronic address: jian@mail.ncku.edu.tw.
authors: Jiann-Shiuh
authors: JS
authors: Chen
authors: Department of Pediatrics, Chi-Mei Hospital, Tainan, Taiwan.
authors: Shio-Jean
authors: SJ
authors: Lin
mesh_terms: D000293:Adolescent; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000453:epidemiology*; D015994:Incidence; D008297:Male; D009765:Obesity / Q000150:complications; D016017:Odds Ratio; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy*; D012189:Retrospective Studies; D012307:Risk Factors; D013624:Taiwan
chemical_list: D000970:Antineoplastic Agents
keywords: Taiwan; acute lymphoblastic leukemia; chemotherapy; children; hyperglycemia