The Incidence of Steroid-Induced Hyperglycemia in Pediatric Patients With Acute Lymphocytic Leukemia

Steroid-induced hyperglycemia (SIH) is a frequent but often overlooked complication in pediatric patients with acute lymphoblastic leukemia (ALL). Corticosteroid use, while essential for treatment, may result in transient or persistent elevations in blood glucose. This study aimed to determine the incidence of SIH and identify potential risk factors.

A retrospective cohort study was conducted on 91 pediatric ALL patients receiving corticosteroids. Hyperglycemia was defined as blood glucose ≥200 mg/dL on at least two occasions, and borderline/transient hyperglycemia as levels between 140 and 199 mg/dL. Blood glucose was monitored throughout therapy, and demographic, clinical, and treatment variables were analyzed for associations with SIH.

Among the 91 patients, 11 (12.1%) developed hyperglycemia and 12 (13.2%) had transient/borderline hyperglycemia, while 68 (74.7%) remained normoglycemic. The onset of SIH occurred between days 2 and 16 of steroid therapy, with peaks on days 4 and 10. Patients receiving dexamethasone (82.4%) had slightly higher rates of hyperglycemia compared to those on prednisolone (17.6%), though not statistically significant (p = 0.663). Similarly, no significant associations were observed with age, gender, body mass index (BMI), or risk stratification. Higher steroid doses showed a trend toward increased risk, but without statistical significance (p = 0.985).

SIH occurred in approximately 1 in 8 pediatric ALL patients, though no significant risk factors were identified. These findings underscore the importance of routine glucose monitoring during corticosteroid therapy, regardless of patient demographics or regimen. Tailored surveillance and early intervention protocols are recommended to mitigate potential complications and improve clinical outcomes.