Evaluating the Incidence of Noninsulin-dependent Diabetes in Acute Promyelocytic Leukemia Patients Undergoing Arsenic Trioxide Therapy: A Population-based Longitudinal Study

Background: Acute promyelocytic leukemia (APL), a subtype of acute leukemia, is treated with arsenic trioxide (ATO). While arsenic exposure is known to increase diabetes risk, the impact of ATO therapy on diabetes in APL patients is unclear. This study evaluates whether ATO contributes to noninsulin-dependent diabetes incidence in APL patients compared to other leukemia patients and the general population. Aim: The study aims to assess the risk of developing diabetes in APL patients receiving ATO, compared to acute myeloid leukemia (AML) patients not on ATO and the general population. It also explores how age, comorbidities, and ATO exposure frequency influence diabetes risk. Methods: This longitudinal cohort study used data from Taiwan’s National Health Insurance Research Database. The study cohort included 330 APL patients treated with ATO, with two comparison cohorts: 1320 AML patients and 1320 individuals from the general population, matched for age, sex, and diagnosis year. Diabetes risk was evaluated using Cox regression, with Kaplan–Meier curves assessing cumulative risk. Results: No significant difference in diabetes incidence was found between APL patients on ATO and the comparison groups. Subgroup analysis suggested a slight increase in risk among elderly APL patients with hyperlipidemia, though not statistically significant. ATO exposure frequency did not affect diabetes risk. Conclusion: ATO therapy does not significantly increase the incidence of noninsulin-dependent diabetes in APL patients. Further studies are needed to confirm the risk in elderly patients and those with hyperlipidemia.