Before joining NIH, I conducted research on how inflammation drives colon cancer. I eventually led a trial to see if certain anti-inflammatory drugs could prevent the colon polyps that can can turn into cancer. The drugs worked; however, they also increased the risk of strokes and heart attacks, so they were not safe for people at high risk of cardiovascular disease.
The trial gave us valuable insight about the risks of these drugs and serves as an example of how clinicians and researchers must consider the needs of the whole patient rather than focusing on one organ system or disease. We have to recognize how certain interventions might improve one health issue but exacerbate another. This is especially important in adult survivors of childhood cancer. We know this population—about 500,000 people living in the U.S. according to 2020 estimates from the National Cancer Institute—faces an increased risk of developing chronic health conditions, including diabetes.
NIH supports numerous researchers working to understand better the health outcomes in childhood cancer survivors. One team at St. Jude Children’s Research Hospital in Memphis has been following more than 3,500 adults who had been diagnosed with childhood cancer. Known as the St. Jude LIFE cohort, the participants undergo regular health screenings and researchers use the information to determine the prevalence and predictors of health issues and to identify interventions to reduce risks.
A new analysis published in the Journal of Clinical Oncology1 shows that prediabetes is highly prevalent in the St. Jude LIFE cohort: about one in every three survivors in the study had prediabetes by a median age of 30, compared to about one in five similarly aged adults without a cancer history. Prediabetes means that a person has higher than normal blood sugar levels but not high enough for a diagnosis of diabetes. Without intervention, many people with prediabetes will later develop diabetes.
By the time survivors in the study entered their 40s, more than half of them had prediabetes or diabetes, putting their future health at more risk compared to the general population. While these findings aren’t good news, they suggest that efforts to detect prediabetes and encourage lifestyle or treatment interventions before survivors go on to have more serious health complications can ensure that more people will live longer, healthier lives.
The research team, led by Stephanie Dixon, found that among 695 survivors with prediabetes who were followed over time, 10 percent progressed to diabetes within five years. The researchers also noted an association between radiation exposure to the pancreas and increased risk of prediabetes and diabetes. The pancreas produces insulin, and people are diagnosed with diabetes when the pancreas does not produce enough insulin to keep up with demand.
Their findings further suggest that, compared to survivors with normal blood sugar levels, those with prediabetes also had higher risk for future heart attack and chronic kidney disease. Those who progressed to diabetes also had more risk for developing stroke or cardiomyopathy (a condition where the heart pumps inefficiently and can lead to heart failure), in the future.
In the general population, prediabetes can be successfully managed through lifestyle changes, such as a healthy diet and exercise, as well as medication to prevent progression to diabetes and related health conditions. While this study is only a first step in identifying the consequences of prediabetes in survivors, it suggests that efforts to identify prediabetes and offer counseling on the importance of diabetes prevention may help more survivors of childhood cancers live long and healthy lives.
References:
[1] SB Dixon, et al. Prediabetes and Associated Risk of Cardiovascular Events and Chronic Kidney Disease Among Adult Survivors of Childhood Cancer in the St Jude Lifetime Cohort. Journal of Clinical Oncology DOI: 10.1200/JCO.23.01005 (2023).
NIH Support: National Cancer Institute
