A Pilot Study Evaluating Steroid-Induced Diabetes after Antiemetic Dexamethasone Therapy in Chemotherapy-Treated Cancer Patients

Abstract

PurposeDexamethasone is a mainstay antiemetic regimen for the prevention of chemotherapy-induced nausea and vomiting. The aim of this pilot study was to assess the incidence of and factors associated with steroid-induced diabetes in cancer patients receiving chemotherapy with dexamethasone as an antiemetic.Materials and MethodsNon-diabetic patients with newly diagnosed gastrointestinal cancer who received at least three cycles of highly or moderately emetogenic chemotherapy with dexamethasone as an antiemetic were enrolled. Fasting plasma glucose levels, 2-hour postprandial glucose levels, and hemoglobin A1C tests for the diagnosis of diabetes were performed before chemotherapy and at 3 and 6 months after the start of chemotherapy. The homeostasis model assessment of insulin resistance (HOMA-IR) was used as an index for measurement of insulin resistance, defined as a HOMA-IR ≥ 2.5.ResultsBetween January 2012 and November 2013, 101 patients with no history of diabetes underwent laboratory tests for assessment of eligibility; 77 of these patients were included in the analysis. Forty-five patients (58.4%) were insulin resistant and 17 (22.1%) developed steroid-induced diabetes at 3 or 6 months after the first chemotherapy, which included dexamethasone as an antiemetic. Multivariate analysis showed significant association of the incidence of steroid-induced diabetes with the cumulative dose of dexamethasone (p=0.049).ConclusionWe suggest that development of steroid-induced diabetes after antiemetic dexamethasone therapy occurs in approximately 20% of non-diabetic cancer patients; this is particularly significant for patients receiving high doses of dexamethasone.

Glucocorticoid‐induced diabetes among people without diabetes: a literature review

“…The following data were extracted from the selected articles: authors, year, country, study design, type of GC studied, dose, duration, sample size, underlying condition (Table ) and results summary (Table ). Of the nine included studies, five were RCTs while the remaining were prospective observational or cross‐sectional studies . All of the studies examined the effect of prednisolone as GC except one which examined dexamethasone .…”

“…Of the nine included studies, five were RCTs while the remaining were prospective observational or cross‐sectional studies . All of the studies examined the effect of prednisolone as GC except one which examined dexamethasone . HOMA was included in the methodology of two of the studies .…”

“…All of the studies examined the effect of prednisolone as GC except one which examined dexamethasone . HOMA was included in the methodology of two of the studies . In addition, two studies used oral glucose tolerance test (OGTT) in their methodology .…”

“…To investigate the incidence of GCID, a prolonged follow‐up period is required to exclude the transient hyperglycaemic effect of GC use. Furthermore, only a few studies examined the effect of GC on glucose homeostasis using homeostatic model assessment (HOMA) and these studies were mostly conducted on non‐human subjects . A few other studies tried to determine the risk factors that predict the development of GCID in those exposed to high‐dose GC …”

Central pancreatectomy: an oncologically safe option to treat metastases of other neoplasms of the mid-portion of the pancreas?

“…It is widely accepted that a central pancreatectomy, of all of the pancreatic resections, has the lowest potential of developing postoperative diabetes 12. Nevertheless, corticosteroids, that are often used to prevent chemotherapy-induced nausea and vomiting, may also induce diabetes in approximately 20% of the non-diabetic patients 2829…”