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A study from St. Jude Children’s Research Hospital sheds light on the incidence of prediabetes and diabetes in childhood cancer survivors for better prevention and treatment. At a younger age, childhood cancer survivors can experience chronic conditions such as diabetes, typically associated with older individuals. Researchers found survivors have twice the risk of developing prediabetes than the general public, which increases their risk of other life-threatening diseases. In the general population, prediabetes can be modified with lifestyle and other interventions, suggesting the potential to improve survivors’ life- and health-spans. The results were published today in the Journal of Clinical Oncology.

“One of the striking features was the very high prediabetes prevalence at such a young age in survivors,” said first and corresponding author Stephanie Dixon, M.D., MPH, St. Jude Department of Oncology. “The problem is over time, more and more people continue to progress to diabetes, so if you develop prediabetes at 20 years old, your lifetime risk of diabetes and associated comorbidities, including atherosclerotic cardiovascular disease or kidney disease, is going to be much higher than if you develop prediabetes at age 40 or 50 years, commonly seen in the general population.”

Prediabetes occurs when a person has higher than normal blood sugar levels but not high enough to be considered diabetic. A large percentage of people with prediabetes will later develop diabetes, which is associated with an increased risk of heart and kidney disease. In the general public, prediabetes can be managed through lifestyle changes, such as a healthy diet and exercise, as well as medication to prevent progression to diabetes and downstream conditions. The study suggests this approach may benefit survivors; however, optimal strategies to reduce the progression toward diabetes among prediabetic survivors remain unknown.

Preventing diabetic disease to protect cancer survivors

Blood sugar levels are well-known to vary naturally. Therefore, physicians may not discuss small elevations with survivors. The findings suggest that even small increases in blood sugar levels should be taken as a sign to start lifestyle interventions in survivors to protect their hearts and kidneys. The key to preventing disease will be identifying survivors with prediabetes as early as possible.

“We need to help survivors understand that prediabetes is really an early warning sign that says you need to do something, whether that’s changing lifestyle, starting medication or following up with primary care,” Dixon said. “But that has to start with physicians identifying when a survivor has developed prediabetes and then counseling the survivor on the importance of diabetes prevention and follow-up.”

Prediabetes associated with heart and kidney problems in survivors

Cardiovascular disease commonly occurs in people with diabetes, but it was unclear if that risk was the same in younger survivors. The findings showed survivors with diabetes are at twice the risk of a heart attack event compared to those with normal blood sugar levels. This impact remained even when accounting for potential organ damage during cancer treatment.

“For cardiovascular disease overall, diabetes alone was associated with a statistically significant increase in risk,” Dixon said. “But when we broke it down, we found a significant increase in risk for heart attack in people with prediabetes, and then for cardiomyopathy (or heart failure) and stroke in people with diabetes.”

In addition to cardiovascular risk, chronic kidney disease was particularly concerning. The researchers observed a three times greater risk of chronic kidney disease in survivors with prediabetes or diabetes.

The study is a first step in identifying the consequences of prediabetes in survivors, which will galvanize future research into adapting approaches to protect these patients.

“We should be considering interventions to mitigate risk in this population of prediabetic and diabetic survivors so they can live longer, healthier lives,” Dixon said.

Reference:

Stephanie B. Dixon, Fang Wang, Lu Lu, Carmen L. Wilson, Daniel M. Green,Thomas E. Merchant, Prediabetes and Associated Risk of Cardiovascular Events and Chronic Kidney Disease Among Adult Survivors of Childhood Cancer in the St Jude Lifetime Cohort, DOI: 10.1200/JCO.23.01005.

वैद्यराज नमस्तुभ्यं यमराज सहोदर ।

यमस्तु हरति प्राणान् वैद्यो प्राणान् धनानि च ॥

This is an ancient saying which means “O vaidya (doctor), brother of Yama (God of Death), I bow down to you. Yama only steals away one’s life, but the vaidya steals one’s life as well as money.” It is obvious that it was a sarcastic manner of equating doctors with Gods.

Life expectancy of Indian citizens was 40 years at the time of independence, it has increased to 75, 75 years after independence. While there are many factors which are responsible for this, doctors of modern medicine have played an important role in enhancing the life expectancy in digital India.

Unfortunately, the cost of healthcare is simultaneously rising because of the cost of technology acquired by hospitals for treatment of diseases hitherto considered untreatable. Increasing consumerism expects a positive outcome of expenses on treatment. Compensation culture is rising exponentially.

There is no doubt that like every other domain, there are black ships in the medical profession also. However, it does not mean that the entire medical profession should be painted with black paint.

Contribution of medical professionals was applauded by all citizens with tali and thali when Prime Minister Narendra Modiji made an appeal during Covid-19 pandemic. Flowers were showered on the corpses of doctors.

More than 2000 doctors have lost their lives while fighting as covid-warriers. Most of their families did not get insurance money. Home minister promised that a Central Act for prevention of violence against will be promulgated, asking IMA to withdraw the candlelight march.

Epidemic Diseases Act 1897 was amended soon after IMA withdrew the protest and only a short term relief was provided. This time IMA was promised change in Bharatiya Nyay Samhita to protect doctors and a statement to that effect was made in parliament.

However, it turns out that section 304A of IPC 1860 has been re-introduced as subsection of 106 (1). Even before this, the intention of parliament was to exclude doctors from the Consumer Protection Act, but it did not reflect in the CPA by mentioning healthcare in the exclusion list.

While doing this, the section 106 (1) creates discrimination between doctors of AYUSH and doctors of modern medicine. IMA consistently opposed crosspathy, but has never opposed AYUSH doctors practising AYUSH sciences, as each science has its advantages and disadvantages.

Doctors need better protection of law, failing which there will be further increase in defensive medicine. This will indirectly harm every citizen of the country by increasing the number of investigations to prove that doctors are not failing in duty to care.

Cost of treatment will continue to rise and soon healthcare in India will become similar to healthcare in the USA where doctors are reluctant to take any risk whatsoever. It is said,

क्वचित् धर्म क्वचित् मैत्री क्वचित् अर्थ क्वचित् यश ।

कर्माभ्यासं क्वचितश्चेति चिकित्सा नास्ती निष्फला ।।

The Vaidya is doing their Dharma in treating patients who come in seeking help, he will make new friends, get connected with new people and receive what is meaningful to them. This could be money and / or something else.

The Vaidya will get success, that which is pleasing to their mind, by feeling satisfaction when patients get results, he will become an expert in managing certain conditions after continuous practice.

People will start finding the Vaidya in exactly the same way as the bee finds nectar in a flower. None of the Vaidya’s efforts, medicines, or prescriptions are going to waste.

Hope good sense will prevail, and the Act will be amended to protect doctors.