Cancer Res Treat.  2016 Oct;48(4):1429-1437. 10.4143/crt.2015.464.

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

• Jeong Y
• Han HS
• Lee HD
• Yang J
• Jeong J
• Choi MK
• Kwon J
• Jeon HJ
• Oh TK
• Lee KH
• Kim ST

• KMID: 2356245
• DOI: http://doi.org/10.4143/crt.2015.464

Abstract

PURPOSE
Dexamethasone 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 METHODS
Non-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.
RESULTS
Between 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).
CONCLUSION
We 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.

Keyword

Antiemetics; Drug therapy; Dexamethasone; Diabetes mellitus

MeSH Terms

Antiemetics
Blood Glucose
Dexamethasone*
Diabetes Mellitus
Diagnosis
Drug Therapy
Fasting
Gastrointestinal Neoplasms
Glucose
Homeostasis
Humans
Incidence
Insulin
Insulin Resistance
Multivariate Analysis
Nausea
Pilot Projects*
Vomiting
Antiemetics
Dexamethasone
Glucose
Insulin

Figure

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  Fig. 1. Flow diagram showing patient selection.

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  Fig. 2. Cumulative dose of dexamethasone. SD, standard deviation. a)p=0.015.

Reference

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