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Severe hypoglycaemia in paediatric oncology: characterisation and risk factors
  1. Zakia Joseph-Frederick1,
  2. Jennifer Keis2,
  3. Gloria Green2,
  4. Ariana Petrazzini1,
  5. Sarah Alexander2,
  6. Anja Kovacevic2,3,
  7. Krista Oei4 and
  8. Lillian Sung2
  1. 1Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
  2. 2Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
  3. 3Pharmacy, The Hospital for Sick Children, Toronto, Ontario, Canada
  4. 4Division of Endocrinology, The Hospital for Sick Children, Toronto, Ontario, Canada
  1. Correspondence to Dr Lillian Sung, Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, M5G1X8, Canada; lillian.sung{at}


Objectives Primary objective was to describe the cumulative incidence of severe hypoglycaemia in paediatric patients with cancer. Secondary objectives were to determine risk factors for severe hypoglycaemia and to describe its clinical course and management.

Methods In this single institution retrospective study, for the cumulative incidence cohort, we included cancer diagnosis and hypoglycaemia episodes between June 2018 and November 2021. For the chart review cohort, we included cancer diagnosis January 2009–November 2021 and hypoglycaemia episodes June 2018–November 2021.

Results There were 1237 cancer diagnoses and 142 patients with severe hypoglycaemia in the cumulative incidence cohort. Cumulative incidence at 6 months after cancer diagnosis was 9.4% (95% CI 7.7% to 11.0%). Severe hypoglycaemia incidence significantly increased over time (r=0.77, p=0.004). Independent risk factors were age at diagnosis (HR 0.88, 95% CI 0.85 to 0.91); acute lymphoblastic leukaemia (HR 3.06, 95% CI 2.19 to 4.29) and relapse (HR 9.54, 95% CI 3.83 to 23.76). There were 4672 cancer diagnoses and 267 episodes of severe hypoglycaemia in the chart review cohort.

Conclusions The cumulative incidence of severe hypoglycaemia 6 months after cancer diagnosis was 9.4%. Severe hypoglycaemia increased over time. Younger patients, those with acute lymphoblastic leukaemia and those with a history of disease relapse, were at higher risk of severe hypoglycaemia.

  • Cancer
  • Paediatrics
  • Symptoms and symptom management

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  • Contributors LS, JK, GG, AK and KO helped to develop the protocol. ZJ-F and AP abstracted the data. LS analysed the data. LS drafted the manuscript. All authors revised the manuscript for important content. All authors agreed to be responsible for the article content.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.