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Case Reports
. 2018 Jul 3;12(1):199.
doi: 10.1186/s13256-018-1690-3.

Glycemic dysregulation in a patient with type 2 diabetes treated with 5-azacitidine: a case report

Antoine Ponard  1   2 , Nicole Ferreira-Maldent  3 , Marjan Ertault  1 , Martine Delain  1 , Kamel Amraoui  1 , Sandra Regina  4 , Annie-Pierre Jonville-Béra  5 , Olivier Hérault  6   7   2 , Philippe Colombat  1   6   2 , Emmanuel Gyan  8   9   10   11
Affiliations
Case Reports

Glycemic dysregulation in a patient with type 2 diabetes treated with 5-azacitidine: a case report

Antoine Ponard et al. J Med Case Rep. .

Abstract

Background: Diabetes and myelodysplastic syndrome are two conditions that may coexist in a single patient, since both diseases are prevalent in the elderly. The pathophysiology of myelodysplastic syndrome involves recurrent genetic mutations, especially in genes controlling epigenetic regulation. Although the pathophysiology of diabetes is not well understood, several studies suggest a role of epigenetics in type 2 diabetes.

Case presentation: We report here for the first time the case of a 75-year-old Caucasian man who was treated for both diabetes and acute myeloid leukemia secondary to myelodysplastic syndrome, with a temporal association between glycemic dysregulation and the intake of 5-azacitidine. In fact, 2-3 days after starting each 7-day cycle of 5-azacitidine, he reported higher blood glucose levels, requiring an increased dose of self-administered insulin.

Conclusion: This observation could help to understand the pathophysiology of these two conditions and could encourage physicians to monitor blood glucose levels in patients under hypomethylating agent with a history of diabetes.

Keywords: Acute myeloid leukemia; Diabetes; Hypomethylating agent; Myelodysplastic syndrome.

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Conflict of interest statement

Consent for publication

The written informed consent we have in the patient’s file has already been approved by a central review Board. Written informed consent was obtained from the patient’s next-of-kin for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.

Competing interests

Emmanuel Gyan has received research funding and travel grants from Celgene, Corp. All other authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Blood smear at diagnosis showed low blast percentage and dyserythropoiesis
Fig. 2
Fig. 2
Marrow smear at diagnosis, showing low blast percentage
Fig. 3
Fig. 3
Marrow smear at progression showing high blast percentage and dyserythropoiesis
Fig. 4
Fig. 4
a Daily mean fasting blood glucose levels from cycles 14 to 19 of 5-azacitidine were recorded. The continuous line represents the mean values for each cycle. The error bars indicate the standard deviation of measurements. b Morning rapid-acting insulin doses. The continuous line represents the mean dose of rapid-acting insulin administered from cycles 14 to 19. The arrows indicate the days of 5-azacitidine injection days 1 to 7
See this image and copyright information in PMC

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