Pediatric Diabetes 2014 doi: 10.1111/pedi.12138 All rights reserved  2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd. Pediatric Diabetes Original Article Medication-induced diabetes during induction treatment for ALL, an early marker for future metabolic risk? Yeshayahu Y, Koltin D, Hamilton J, Nathan PC, Urbach S. Medication-induced diabetes during induction treatment for ALL, an early marker for future metabolic risk?. Pediatric Diabetes 2014. Medication-induced diabetes (MID) is seen in children treated for acute lymphoblastic leukemia (ALL) mostly during induction, due to the use of l-asparaginase and glucocorticoids. Our objective was to assess whether MID during induction, is a risk factor for future impaired glucose tolerance (IGT), diabetes, or metabolic syndrome. Ninety survivors of pediatric ALL, ages 10 yr and older were recruited, 30 with history of MID and 60 controls. Waist/height ratio >0.5 was considered as an increased risk for central adiposity and insulin resistance. Lipid profile and an oral glucose tolerance test (OGTT) were performed. Study patients were older than controls (17.2 vs. 14.9, p < 0.05). The groups had similar sex distribution, body mass index (BMI) z-score, and Tanner staging. A waist/height ratio of >0.5 was seen in 60 and 31.7% of the study and control groups, respectively (p = 0.01). Increased frequency of IGT in the study group compared with the control group was seen (13.3 and 1%, respectively) (p = 0.07). We observed a trend toward higher proportion of patients with multiple features of metabolic syndrome in the study compared with control group (16.7 vs. 5%, p = 0.09). In conclusion, MID during induction may be an early marker for metabolic disturbances later in life. The higher rates of increased waist/height ratio, and subjects with multiple metabolic syndrome features, may predict a metabolic risk in children with history of MID. Rates of IGT were four fold higher in the study group although not statistically significant. MID may be a ‘red flag’ indicating the need for ongoing metabolic screening and lifestyle modifications to prevent future metabolic disease. Yonatan Yeshayahu a,b,† , Dror Koltin c,d,† , Jill Hamilton c,d , Paul C. Nathan d,e and Stacey Urbach c,d a Division of Endocrinology, Safra Children’s Hospital, Ramat Gan, Israel; b Department of Pediatrics, Tel-Aviv University, Tel-Aviv, Israel; c Division of Endocrinology, The Hospital for Sick Children, Toronto, ON, Canada; d Department of Pediatrics, University of Toronto, Toronto, ON, Canada; and e Division of Haematology Oncology, The Hospital for Sick Children, Toronto, ON, Canada † Contributed equally to the study and the manuscript. Key words: acute lymphoblastic leukemia – diabetes – impaired glucose tolerance – medication-induced diabetes – metabolic syndrome Corresponding author: Yonatan Yeshayahu, MD, MHA, Division of Endocrinology, Safra Children’s Hospital, Tel-Hashomer, Ramat Gan 52621, Israel. Tel: (972) 3-5305015; fax: (972) 3-5305055; e-mail: Yonatan.yeshayahu@sheba.health.gov.il Submitted 26 November 2013. Accepted for publication 21 February 2014 Acute lymphoblastic leukemia (ALL) is the most common childhood malignancy accounting for one third of cases of childhood cancer (1). Medication- induced diabetes (MID) has been well described in children receiving therapy for ALL (2). This complication is seen mostly during remission induc- tion, and is attributed to specific chemotherapeutic agents, such as l-asparaginase causing pancreatic β-cell dysfunction, and glucocorticoids leading to insulin resistance (2, 3). The prevalence of MID during 1