Determining the associations between glucocorticoid use during hematological chemotherapy treatment and new-onset diabetes and hyperglycemia and mortality: a population-based cohort study

OBJECTIVES:The aim of this study was to determine the associations between glucocorticoid administration during chemotherapy for hematological malignancy and hyperglycemia, new-onset diabetes, and mortality in Ontario, Canada. Hospitalization and Emergency Room utilization during the chemotherapy treatment period was also described. METHODS:We conducted a retrospective cohort study using health administrative data from ICES, Ontario to investigate risk of new-onset diabetes, new-onset hyperglycemia and hyperglycemia for individuals with leukemia, non-Hodgkin lymphoma (NHL) and Hodgkin lymphoma (HL) receiving glucocorticoids during chemotherapy between 2006 and 2016. Using multivariable regression models, we determined the associations between glucocorticoid exposure and our outcomes of interest, controlling for age, sex, marginalization and comorbidities RESULTS: Our cohort included 19,530 individuals; 71.1% (n=13,893) received a glucocorticoid. The highest proportion of hyperglycemia occurred with leukemia (25.4%, n=1,301). Of the 15,580 individuals with no history of diabetes, those with leukemia had the highest rate of new-onset diabetes (7.1%, n=279) and new-onset hyperglycemia (18.1%, n=641) and glucocorticoid exposure increased the risk of new-onset diabetes (HR 1.29; 95% CI 1.01-1.64; P=0.04) and new-onset hyperglycemia (HR 1.28; 95% CI 1.09-1.5; P =0.003). Hyperglycemia during chemotherapy increased the risk of all-cause mortality for the combined (HR 1.18; 95% CI 1.09-1.27; P=<0.0001) and NHL (HR 1.16; 95% CI 1.04-1.28; P=0.007) cohorts. CONCLUSIONS:Hyperglycemia is common during hematological chemotherapy treatment and associated with a modest increased risk of all-cause mortality. Routine screening, monitoring and management of hyperglycemia should be an integral part of treatment plans for leukemia, NHL or HL, with or without glucocorticoid administration.