The development of non-insulin-dependent diabetes after total body irradiation and bone marrow transplantation in adolescence: a case report and literature review

A 6-yr-old-child received total body irradiation (TBI) and bone marrow transplantation (BMT) for relapsed acute lymphocytic leukemia. Nine years later, he developed diabetes mellitus (DM). He was started on basal bolus insulin therapy. Islet cell and anti-GAD antibodies were negative. Insulin and C-peptide levels were elevated consistent with insulin resistance (IR), even though his body mass index (BMI) was only 19.5. Hepatocyte nuclear factor (HNF-1alpha) mutation was not detected. Insulin was stopped and hemoglobin Alc (HbA1c) stabilized at 6.5% on gliclazide 40 mg/day. TBI has rarely been associated with IR and the development of diabetes. These patients can be managed with oral hypoglycemic agents and do not necessarily require insulin. Patients who received BMT and TBI may require long-term monitoring of glucose and lipid metabolism.