Male sex, impaired fasting glucose predict diabetes incidence during chemo with steroids

As many as 6 percent of cancer patients receiving chemotherapy with dexamethasone develop new-onset diabetes, and this risk is pronounced in men with impaired fasting glucose (IFG), according to a study.

The multicentre cohort study involved 299 diabetes-free patients with breast or colorectal cancer (aged >18 years) and scheduled to undergo 4–8 cycles of adjuvant chemotherapy. The endpoints were the incidence, remission rate, and independent determinants of new-onset diabetes during chemotherapy.

Of the patients, 270 (mean age, 51.0 years) completed the follow up (mean, 39 months). A total of 17 patients (6.3 percent) developed diabetes within a median of 90 days after treatment initiation.

The risk of new-onset diabetes was about 15-fold higher among men (vs women: hazard ratio [HR], 15.839, 95 percent confidence interval [CI], 2.004–125.20) and eightfold greater among those with IFG at baseline (vs no IFG; HR, 8.307, 95 percent CI, 1.826–37.786).

Six months after completion of chemotherapy, diabetes remission occurred in 11 out of 17 patients (64.7 percent). Remission was associated with a significantly higher C-peptide level at baseline (1.3 ng/mL in patients with remission vs 0.9 ng/mL in those without remission; age- and sex-adjusted, p=0.007).

The findings underscore the importance of close monitoring for hyperglycaemia in cancer patients on chemotherapy with steroids, especially men with IFG.