Важные аспекты развития нарушения углеводного обмена у онкогематологических больных на фоне терапии глюкокортикостероидами: обзор литературы

Глюкокортикостероиды – высокоэффективные противовоспалительные и иммуносупрессивные средства. В терапевтическую практику препараты были внедрены с середины XX века и до настоящего времени широко используются в лечении различных заболеваний. Они являются неотъемлемой частью терапии пациентов с онкогематологическими заболеваниями. Одно из клинически значимых осложнений терапии глюкокортикостероидами – стероидиндуцированное нарушение метаболизма углеводов. Сахарный диабет – один из основных факторов риска развития кардиоваскулярных заболеваний, которые являются основной неонкологической причиной смерти населения и существенным осложнением терапии лиц со злокачественными новообразованиями. Раннее выявление заболевания и улучшение эффективности лечения повышают выживаемость пациентов с новообразованиями различных типов. Также важно уделять внимание повышению качества жизни онкологических больных после проведенного лечения.

Цель данного обзора – анализ особенностей патогенеза развития, а также предикторов раннего выявления и предупреждения развития возможных осложнений персистенции гипергликемии у онкогематологических больных.

1. Злокачественные новообразования в России в 2020 году (заболеваемость и смертность). Под ред. А.Д. Каприна, В.В. Старинского, А.О. Шахзадовой. М.: МНИОИ им. П.А. Герцена – филиал ФГБУ «НМИЦ радиологии» Минздрава России, 2021. 252 с.

2. Healy S.J., Nagaraja H.N., Alwan D., Dungan K.M. Prevalence, predictors, and outcomes of steroid-induced hyperglycemia in hospitalized patients with hematologic malignancies. Endocrine 2017;56(1):90–7. DOI: 10.1007/s12020-016-1220-2

3. Harris D., Barts A., Connors J. et al. Glucocorticoid-induced hyperglycemia is prevalent and unpredictable for patients undergoing cancer therapy: an observational cohort study. Curr Oncol 2013;20(6):e532–8. DOI: 10.3747/co.20.1499

4. Hwangbo Y., Kang D., Kang M. et al. Incidence of diabetes after cancer development: a Korean national cohort study. JAMA Oncol 2018;4(8):1099–105. DOI: 10.1001/jamaoncol.2018.1684

5. Toyoshima M.T.K., Cukier P., Souza A.B.C. et al. Effects of glucocorticoids on interstitial glucose concentrations in individuals with hematologic cancer and without known diagnosis of diabetes: a pilot study. Einstein (Sao Paulo) 2022;20:eAO8031. DOI: 10.31744/einstein_journal/2022AO8031

6. Hiestand A., Flory J., Chitkara R. Hospitalization as an opportunity to optimize glycemic control in oncology patients. Curr Diab Rep 2019;19(12):149. DOI: 10.1007/s11892-019-1283-6

7. Wu L., Jiao Y., Li Y. et al. Hepatic Gadd45β promotes hyperglycemia and glucose intolerance through DNA demethylation of PGC-1α. J Exp Med 2021;218(5):e20201475. DOI: 10.1084/jem.20201475

8. Dehghani M., Hobbi A.M., Haghighat S. et al. Glucocorticoid induced diabetes and lipid profiles disorders amongst lymphoid malignancy survivors. Diabetes Metab Syndr 2020;14(6):1645–9. DOI: 10.1016/j.dsx.2020.08.027

9. Chang K.H., Hwang W.L., Muo C.H. et al. Outcome and late effects among acute myeloid leukemia survivors: a nationwide population-based study. Support Care Cancer 2016;24(12): 4993–5000. DOI: 10.1007/s00520-016-3361-5

10. Vidler J., Rogers C., Yallop D. et al. Outpatient management of steroid-induced hyperglycaemia and steroid-induced diabetes in people with lymphoproliferative disorders treated with intermittent high dose steroids. J Clin Transl Endocrinol 2017;9: 18–20. DOI: 10.1016/j.jcte.2017.06.003

11. Ochola L.A., Nyamu D.G., Guantai E.M., Weru I.W. Metformin’s effectiveness in preventing prednisone-induced hyperglycemia in hematological cancers. J Oncol Pharm Pract 2020;26(4):823–34. DOI: 10.1177/1078155219873048

12. Селимов А.Ю., Елисеева Л.Н., Куринная В.П., Оранский С.П. Нарушения обмена глюкозы у пациентов, принимающих глюкокортикостероиды: особенности клинических проявлений и коррекции. Кубанский научный медицинский вестник 2019;26(1):209–18. DOI: 10.25207/1608-6228-2019-26-1-209-218

13. Agudo-Tabuenca A., Gimeno-Orna J.A., Sáenz-Abad D. Assessment of the efficacy and safety of a protocol to manage glucocorticoid-induced hyperglycemia in diabetic patients during hospital stay. Endocrinol Diabetes Nutr 2019;66(6):353–60. DOI: 10.1016/j.endinu.2019.01.008

14. Wallace M.D., Metzger N.L. Optimizing the treatment of steroid-induced hyperglycemia. Annal Pharmacother 2018;52(1):86–90. DOI: 10.1177/1060028017728297

15. Vu K., Busaidy N., Cabanillas M.E. et al. A randomized controlled trial of an intensive insulin regimen in patients with hyperglycemic acute lymphoblastic leukemia. Clin Lymphoma Myeloma Leuk 2012;12(5):355–62. DOI: 10.1016/j.clml.2012.05.004

16. Beaupere C., Liboz A., Fève B. et al. Molecular mechanisms of glucocorticoid-induced insulin resistance. Int J Mol Sci 2021;22(2):623. DOI: 10.3390/ijms22020623

17. Welsch S., Sawadogo K., Brichard B. et al. Characterization and risk factors of hyperglycaemia during treatment of childhood hematologic malignancies. Diabet Med 2022;39(2):e14720. DOI: 10.1111/dme.14720

18. Suh S., Park M.K. Glucocorticoid-induced diabetes mellitus: an important but overlooked problem. Endocrinol Metab 2017;32(2):180–9. DOI: 10.3803/EnM.2017.32.2.180

19. Bonaventura A., Montecucco F. Steroid-induced hyperglycemia: an underdiagnosed problem or clinical inertia? A narrative review. Diabetes Res Clin Pract 2018;139:203–20. DOI: 10.1016/j.diabres.2018.03.006

20. Gebauer J., Fick E.M., Waldmann A. et al. Self-reported endocrine late effects in adults treated for brain tumours, Hodgkin and non-Hodgkin lymphoma: a registry based study in Northern Germany. Eur J Endocrnol 2015;173(2):139–48. DOI: 10.1530/eje-15-0174

21. Hirabayashi K., Nakazawa Y., Matsuura H. et al. Risk factors for diabetes mellitus and impaired glucose tolerance following allogeneic hematopoietic stem cell transplantation in pediatric patients with hematological malignancies. Int J Hematol 2014;99(4):477–86. DOI: 10.1007/s12185-014-1536-8

22. Li C., Liu P., Liu L. et al. Metabolic syndrome in hematologic malignancies survivors: a meta-analysis. Med Oncol 2015;32(1):422. DOI: 10.1007/s12032-014-0422-9

23. Šimkovič M., Vodárek P., Motyčková M. et al. Rituximab, cyclophosphamide and dexamethasone (RCD) chemoimmunotherapy for relapsed chronic lymphocytic leukaemia. Eur J Clin Invest 2020;51(4):e13421. DOI: 10.1111/eci.13421

24. Ceccarelli E., Mattaliano C., Brazzi A. et al. Hyperglycemia and diabetes induced by glucocorticoids in nondiabetic and diabetic patients: revision of literature and personal considerations. Curr Pharm Biotechnol 2018;19(15):1210–20. DOI: 10.2174/1389201020666190102145305

25. Cavataio M.M., Packer C.D. Steroid-induced diabetic ketoacidosis: a case report and review of the literature. Cureus 2022;14(4):e24372. DOI: 10.7759/cureus.24372

26. Jung S.H., Jang H.C., Lee S.S. et al. The impact of hyperglycemia on risk of severe infections during early period of induction therapy in patients with newly diagnosed multiple myeloma. Biomed Res Int 2014;2014:413149. DOI: 10.1155/2014/413149

27. Weiser M.A., Cabanillas M.E., Konopleva M. et al. Relation between the duration of remission and hyperglycemia during induction chemotherapy for acute lymphocytic leukemia with a hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone/methotrexate-cytarabine regimen. Cancer 2004;100(6):1179–85. DOI: 10.1002/cncr.20071

28. Gonzalez-Gonzalez J.G., Mireles-Zavala L.G., Rodriguez-Gutierrez R. et al. Hyperglycemia related to high-dose glucocorticoid use in noncritically ill patients. Diabetol Metab Syndr 2013;5:18. DOI: 10.1186/1758-5996-5-18

29. Lee S.Y., Kurita N., Yokoyama Y. et al. Glucocorticoid-induced diabetes mellitus in patients with lymphoma treated with CHOP chemotherapy. Support Care Cancer 2014;22(5):1385–90. DOI: 10.1007/s00520-013-2097-8

30. Bostrom B.C., Sensel M.R., Sather H.N. et al. Dexamethasone versus prednisone and daily oral versus weekly intravenous mercaptopurine for patients with standard-risk acute lymphoblastic leukemia: a report from the Children’s Cancer Group. Blood 2003;101(10):3809–17. DOI: 10.1182/blood-2002-08-2454

31. Teuffel O., Kuster S.P., Hunger S.P. et al. Dexamethasone versus prednisone for induction therapy in childhood acute lymphoblastic leukemia: a systematic review and meta-analysis. Leukemia 2011;25(8):1232–8. DOI: 10.1038/leu.2011.84

32. Bielorai B., Pinhas-Hamiel O. Type 2 diabetes mellitus, the metabolic syndrome, and its components in adult survivors of acute lymphoblastic leukemia and hematopoietic stem cell transplantations. Curr Diab Rep 2018;18(6):32. DOI: 10.1007/s11892-018-0998-0

33. Lamar Z.S., Dothard A., Kennedy L. et al. Hyperglycemia during first-line R-CHOP or dose adjusted R-EPOCH chemotherapy for non-Hodgkin lymphoma is prevalent and associated with chemotherapy alteration – a retrospective study. Leuk Lymphoma 2018;59(8):1871–7. DOI: 10.1080/10428194.2017.1410889

34. Pagano G., Cavallo-Perin P., Cassader M. et al. An in vivo and in vitro study of the mechanism of prednisone-induced insulin resistance in healthy subjects. J Clin Invest 1983;72(5): 1814–20. DOI: 10.1172/JCI111141

35. Weinstein S.P., Wilson C.M., Pritsker A., Cushman S.W. Dexamethasone inhibits insulin-stimulated recruitment of GLUT4 to the cell surface in rat skeletal muscle. Metabolism 1998;47(1): 3–6. DOI: 10.1016/s0026-0495(98)90184-6

36. Seckl J.R., Morton N.M., Chapman K.E., Walker B.R. Glucocorticoids and 11beta-hydroxysteroid dehydrogenase in adipose tissue. Recent Prog Horm Res 2004;59:359–93. DOI: 10.1210/rp.59.1.359

37. Linssen M.M., van Raalte D.H., Toonen E.J. et al. Prednisolone-induced beta cell dysfunction is associated with impaired endoplasmic reticulum homeostasis in INS-1E cells. Cell Signal 2011;23(11):1708–15. DOI: 10.1016/j.cellsig.2011.06.002

38. Esguerra J.L.S., Ofori J.K., Nagao M. et al. Glucocorticoid induces human beta cell dysfunction by involving riborepressor GAS5 LincRNA. Mol Metab 2020;32:160–7. DOI: 10.1016/j.molmet.2019.12.012

39. Roberts A., James J., Dhatariya K. Management of hyperglycaemia and steroid (glucocorticoid) therapy: a guideline from the Joint British Diabetes Societies (JBDS) for Inpatient Care group. Diabetic Med 2018;35(8):1011–7. DOI: 10.1111/dme.13675

40. Dev R., Bruera E., Dalal S. Insulin resistance and body composition in cancer patients. Ann Oncol 2018;29(suppl_2):ii18–26. DOI: 10.1093/annonc/mdx815

41. Tanaka K., Okada Y., Mori H. et al. The effects of mitiglinide and repaglinide on postprandial hyperglycemia in patients undergoing methylprednisolone pulse therapy. Intern Med 2018;57(1):65–70. DOI: 10.2169/internalmedicine.9013-17

42. Boren J., Cascante M., Marin S. et al. Gleevec (STI571) influences metabolic enzyme activities and glucose carbon flow toward nucleic acid and fatty acid synthesis in myeloid tumor cells. J Biol Chem 2001;276(41):37747–53. DOI: 10.1074/jbc.M105796200

43. Clore J.N., Thurby-Hay L. Glucocorticoid-induced hyperglycemia. Endocr Pract 2009;15(5):469–74. DOI: 10.4158/EP08331.RAR

44. Perez A., Jansen-Chaparro S., Saigi I. et al. Glucocorticoid-induced hyperglycemia. J Diabetes 2014;6(1):9–20. DOI: 10.1111/1753-0407.12090

45. Zarkovic M., Beleslin B., Ciric J. et al. Glucocorticoid effect on insulin sensitivity: a time frame. J Endocrinol Invest 2008;31(3):238–42. DOI: 10.1007/BF03345596

46. Gounden V., Ngu M., Anastasopoulou C., Jialal I. Fructosamine. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing, 2022.

47. Olczuk D., Priefer R. A history of continuous glucose monitors (CGMs) in self-monitoring of diabetes mellitus. Diabetes Metab Syndr 2018;12(2):181–7. DOI: 10.1016/j.dsx.2017.09.005

48. Fonseca V.A., Grunberger G., Anhalt H. et al. Continuous glucose monitoring: a consensus conference of the American Association of Clinical Endocrinologists and American College of Endocrinology. Endocr Pract 2016;22(8):1008–21. DOI: 10.4158/EP161392.CS

49. Seelig E., Meyer S., Timper K. et al. Metformin prevents metabolic side effects during systemic glucocorticoid treatment. Eur J Endocrinol 2017;176(3):349–58. DOI: 10.1530/EJE-16-0653

50. Willi S.M., Kennedy A., Brant B.P. et al. Effective use of thiazolidinediones for the treatment of glucocorticoid-induced diabetes. Diabetes Res Clin Pract 2002;58(2):87–96. DOI: 10.1016/s0168-8227(02)00127-4

51. Wu W., Merriman K., Nabaah A. et al. The association of diabetes and anti-diabetic medications with clinical outcomes in multiple myeloma. Br J Cancer 2014;111(3):628–36. DOI: 10.1038/bjc.2014.307

52. De Micheli A. [Corticosteroid induced diabetes mellitus: diagnosis and management] (In Italian). G Ital Nefrol 2016;33(S68):gin/33.S68.7.

53. Ali N.A., O’Brien J.M.Jr, Blum W. et al. Hyperglycemia in patients with acute myeloid leukemia is associated with increased hospital mortality. Cancer 2007;110(1):96–102. DOI: 10.1002/cncr.22777

54. Кувшинов А.Ю., Волошин С.В., Кузяева А.А. и др. Современные представления о CAR-T-клеточной терапии. Вестник гематологии 2019;15(2):4–13.