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Drug induced Diabetes Mellitus (DIDM) in Pediatric Acute Lymphoblastic Leukemia (ALL): Approach to diagnosis and management
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  • Koushik Handattu,
  • Lokesh Sharma,
  • Kalasekhar Vijayasekharan,
  • Vasudeva K,
  • Shrikiran Aroor,
  • Siddhnath Sudhanshu
Koushik Handattu
Kasturba Medical College Manipal

Corresponding Author:koushik.h@manipal.edu

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Lokesh Sharma
Sanjay Gandhi Post Graduate Institute of Medical Sciences
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Kalasekhar Vijayasekharan
Regional Cancer Centre Thiruvananthapuram
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Vasudeva K
Kasturba Medical College Manipal
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Shrikiran Aroor
Kasturba Medical College Manipal
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Siddhnath Sudhanshu
Sanjay Gandhi Post Graduate Institute of Medical Sciences
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Abstract

Corticosteroids and L-asparaginase used in the treatment of pediatric acute lymphoblastic leukemia (ALL) results in Drug induced Diabetes Mellitus (DIDM). Literature on the management of DIDM among children with ALL is sparse and the diagnostic criteria for pediatric diabetes should be carefully applied considering the acute and transient nature of DIDM during ALL therapy. Insulin remains the standard of care for DIDM management and the choice of Insulin regimen (standalone Neutral Protamine Hagedorn (NPH) or basal bolus) should be based on the type and dose of steroids used for ALL and the pattern of hyperglycemia. A modest glycemic control (140-180 mg/dl) to achieve euglycemia and prevent hypoglycemia would be the general approach. This review is intended to suggest a evidence based practical guidance in the diagnosis and management of DIDM during pediatric ALL therapy.