Steroid-Induced Diabetes Mellitus Caused by Dexamethasone Used for Prevention of Chemotherapy-Induced Nausea and Vomiting: A Cross-Sectional Hospital-Based Observational Study

Introduction: New onset diabetes is often noticed when steroids are used especially in higher dosage and for a prolonged duration. Aim of this study was to estimate the proportion of patients’ developing new onset diabetes mellitus after receiving dexamethasone for the prevention of Chemotherapy induced nausea and vomiting (CINV). Methods: A prospective hospital based observational study was conducted from May, 2018 to April 2019 on chemotherapy treated cancer patients of the clinical oncology department of Bir hospital in Kathmandu who were kept on dexamethasone for the prevention of CINV. Inclusion criteria was: Adult cancer patients who were prescribed chemotherapy along with dexamethasone for the prevention of CINV. Exclusion criteria were: Previously diagnosed cases of diabetes mellitus or patients diagnosed of any other similar conditions or patients were using any other drugs (including long term steroid therapy for other conditions) known to cause hyperglycemia/ diabetes mellitus. At 0, 3 or 6 months of follow up patients were tested for blood sugar or HBA1c for the evaluation of onset of diabetes mellitus. In newly diagnosed diabetic cases a cumulative dose and duration of dexamethasone use were calculated and analyzed for their relationships and tested for statistical significance. X2 test or fisher exact test, and t or z tests were applied depending on variable and sample size. Regression analysis was performed to examine the associations. Result: A total of 47 patients were evaluated for the onset of dexamethasone (used for the prevention of CINV) induced diabetes mellitus during the study period from May, 2018 to April 2019. Out of 47 patients evaluated, we found 6 (12.7%) patients of new onset diabetes mellitus requiring anti diabetic treatment due to dexamethasone therapy even after withdrawal of dexamethasone. The higher (5/6) number of patients developed diabetes after getting ≥3 days cycles and ≥20mg/day cumulative dose of dexamethasone per cycle. Obese patients developed diabetes mellitus more frequently than non-obese patients. Diabetes mellitus were found more frequently when they were prescribed dexamethasone along with Oxaliplatin, Paclitaxel, CAF, CAV, CAPOX and TAC regimens (Table 2). However, none of the above findings were found statistically significant. Conclusion: Incidence of dexamethasone induced diabetes mellitus used for prevention of CINV was found to be around 13% (p-0.81).