P-303: Dual burden: chemotherapy-induced diabetes in twin siblings with acute lymphoblastic leukemia in Nigeria: a case report
O Oladipo, E Oyenusi, U Fakile, A Akinsete, A OduwoleAbstract
Introduction
Chemotherapy-induced metabolic complications are increasingly recognized in paediatric oncology, yet the occurrence of chemotherapy-induced diabetes mellitus (CIDM) remains underreported, particularly in the paediatric population in low-resource settings.
Objectives
This case report describes the development of CIDM in a set of twins undergoing treatment for Acute Lymphoblastic Leukemia (ALL) in Nigeria, highlighting clinical presentation, management challenges, and implications for care.
Methods
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Results
Case description: Twin siblings diagnosed with Leukemia were managed with the same chemotherapy protocols including high doses of glucocorticoids and L-asparaginase. Seven days into treatment, the first twin had generalized boils and poor intravenous site wound healing, urinalysis showed glycosuria and absent ketonuria, fasting blood glucose (FBG) was 7.4mmol/L, glycosylated haemoglobin A1c (HbA1c) showed diabetic levels of 7.7% (4 – 5.6%). About two years later, the second twin was also diagnosed with leukemia. She was screened at the commencement of therapy, she had hyperglycaemia, her HbA1C was 6.6% and C-peptide was 392 pmol/L (260 - 1728). There is a history of DM in their maternal grandma but neither of them had a prior history of diabetes and both of them had normal body mass index. Management involved insulin therapy with close glucose monitoring. The coexistence of ALL and CIDM posed significant challenges, including balancing glycemic control with the continuation of life-saving chemotherapy, as well as financial and psychosocial burdens on the family. However, early detection of hyperglycaemia presented an opportunity for intervention prior to the onset of DKA. Despite these challenges, both patients showed improvement in glycemic control and subsequent resolution of the CIDM with appropriate multidisciplinary care.
Conclusions
Active screening for possible CIDM prevents delayed diagnosis and management and is critical to averting life-threatening complications like diabetic ketoacidosis.