How do I manage hyperglycemia/post-transplant diabetes mellitus after allogeneic HSCT

Abstract

Allogeneic hematopoietic stem cell transplantation (allo-HSCT) recipients frequently develop glucose intolerance and post-transplant diabetes mellitus (PTDM). The clinical importance of PTDM and its detrimental impact on HSCT outcomes are underrecognized. After allo-HSCT, various mechanisms can contribute to the development of PTDM. Here we review information about hyperglycemia and PTDM after allo-HSCT as well as PTDM after solid organ transplantation and describe ways to manage hyperglycemia/PTDM after allogeneic HSCT. Taking into consideration a lack of well-established evidence in the field of allo-HSCT, more studies should be conducted in the future, which will require closer multidisciplinary collaboration between hematologists, endocrinologists and nutritionists.

National Institutes of Health Hematopoietic Cell Transplantation Late Effects Initiative: The Cardiovascular Disease and Associated Risk Factors Working Group Report

“…55 Dysregulated glucose homeostasis may persist beyond this first phase or emerge during long-term follow-up in the form of 3 related entities: 1) Type 2 Diabetes Mellitus (T2DM), encompassing conditions characterized by hyperglycemia due to various degrees of impairment of insulin secretion or action; 56 2) pre-diabetic states (PDS) where fasting or post-prandial glucose levels are chronically above the normal range without reaching those diagnostic of DM; 57, 58 and 3) Insulin resistance (IR), a metabolic trait that predisposes to PDS and type 2 DM, the most prevalent form of DM in the general adult population. 56 …”

Measurement of Hyperglycemia and Impact on Health Outcomes in People With Cancer: Challenges and Opportunities

“…Emerging studies have shown that among people with cancer, those who have received hematopoietic cell transplant, are at higher risk for diabetes following treatment (Clark, Savani, Mohty, & Savani, 2016; Fuji et al, 2016). Therefore, it is imperative that hyperglycemia be accurately measured in order to be well managed.…”

Hyperglycemia as a possible risk factor for mold infections—the potential preventative role of intensified glucose control in allogeneic hematopoietic stem cell transplantation

“…Patients often have hyperglycemia after allogeneic HSCT, as reviewed recently. 5,59 Considering the importance of neutrophil function in the control of bacterial infections, we can assume that better glucose control might reduce the risks of both bacterial and fungal infections. In particular, glucose control after allogeneic HSCT during the early neutropenic period could be crucial, as the risk of bacterial and fungal infections is high due to profound neutropenia, and the risk of developing hyperglycemia is also high due to various causes such as inflammation associated with conditioning regimens and total parenteral nutrition.…”

“…Several treatment procedures, such as solid organ transplantation and hematopoietic stem cell transplantation (HSCT), are intrinsically associated with a high risk of mold infections and also correlated with an increased risk of post-transplant DM. 5 The mechanism whereby the presence of DM affects the incidence of mold infections in such cases is intriguing. Here, we aim to summarize the information about the increased risk of mold infections in patients with DM, and propose possible interventions to reduce this risk.…”