RETROSPECTIVE ANALYSIS OF A HYPERGLYCEMIA SCREENING PROTOCOL IN PEDIATRIC PATIENTS WITH ALL AND LLY

RETROSPECTIVE ANALYSIS OF A HYPERGLYCEMIA SCREENING PROTOCOL IN PEDIATRIC PATIENTS WITH ALL AND LLY

Mike Levitt, MSa

Garland Siebert, MSa

Rachel Hill, RD, CSO, LD, CNSCb

Tyler Hamby, PhDa,c

Ashraf Mohamed, MDb

aUniversity of North Texas Health Science Center, Texas College of Osteopathic Medicine

bCook Children’s Health Care System, Department of Pediatric Hematology/Oncology

cCook Children’s Health Care System, Department of Research Operations

Background: Approximately 4-35% of pediatric patients undergoing treatment for acute lymphoblastic leukemia (ALL) and lymphoblastic lymphoma (LLy) develop drug-induced hyperglycemia. Hyperglycemia is associated with poor outcomes including increased infections, weight loss, diabetic ketoacidosis, and greater mortality. However, no guidelines for identifying drug-induced hyperglycemia currently exist and the time course of hyperglycemia development remains relatively uncharacterized past induction therapy.

Objective: The present study aims to evaluate a hyperglycemia screening protocol (HSP) that was implemented to identify hyperglycemia more promptly and to further describe the time course of hyperglycemia during ALL and LLy therapy.

Design/Methods: A retrospective medical records review of 154 patients diagnosed with ALL or LLy at Cook Children’s Medical Center between March 2018 and April 2022 was performed. The HSP included more frequent blood glucose monitoring, criteria for removal of dextrose from IV fluids, consultation with other providers (case management, patient educator, registered dietitian), and robust care coordination between the hematology-oncology and endocrinology teams. Predictors of hyperglycemia were examined with univariate Cox regression.

Results: The HSP was ordered for 88 (57%) of the patients. Fifty-four (35%) patients developed hyperglycemia: 28 (52%) during induction therapy and 26 (48%) patients after induction therapy. Enrollment in the HSP increased the likelihood of a hyperglycemia diagnosis compared to those not enrolled (41% vs. 27%, HR=1.76, p<0.050). Age ³10 years was an independent predictor of hyperglycemia development (HR=3.72, p<0.0001). Patients who did not gain weight during the induction period were more likely to also have hyperglycemia (weight loss: HR=5.42, p=0.001; weight steady: HR=3.48, p=0.012). The development of pancreatitis was also associated with drug-induced hyperglycemia (HR=2.45, p=0.007). Blood glucose values were significantly more likely to be ³ 200 mg/dL during days 5-8 of induction therapy compared to days 1-4 (29% vs. 10%, OR=4.18, p<0.001). Compared to blood glucose measurements taken in the morning (10%), values were more likely to be ≥200 mg/dL when acquired overnight (20%, OR=4.42, p<0.001), in the afternoon (16%, OR=2.34, p=0.011), and in the evening (38%, OR=10.57, p<0.001).

Conclusion: Implementation of the HSP helped detect hyperglycemia more frequently in enrolled patients compared to controls and readily identified individuals at the greatest risk of developing hyperglycemia. These findings highlight a population of patients that develop hyperglycemia past induction therapy and give guidance on the timing of continued blood glucose monitoring in at-risk patients.