Ponard Antoine, Ferreira-Maldent Nicole, Ertault Marjan, Delain Martine, Amraoui Kamel, Regina Sandra, Jonville-Béra Annie-Pierre, Hérault Olivier, Colombat Philippe, Gyan Emmanuel
Service d'hématologie et thérapie cellulaire, Centre hospitalier universitaire, 2 boulevard Tonnellé, 37044, Tours, France.
Faculté de Médecine, Université François Rabelais, Tours, France.
J Med Case Rep. 2018 Jul 3;12(1):199. doi: 10.1186/s13256-018-1690-3.
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.
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.
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.
糖尿病和骨髓增生异常综合征是两种可能在同一患者中并存的疾病，因为这两种疾病在老年人中都很常见。骨髓增生异常综合征的病理生理学涉及反复的基因突变，尤其是在控制表观遗传调控的基因中。虽然糖尿病的病理生理学尚未完全了解，但多项研究表明表观遗传学在2型糖尿病中起作用。
我们在此首次报告一例75岁的白人男性病例，该患者因糖尿病和骨髓增生异常综合征继发的急性髓系白血病接受治疗，血糖失调与阿扎胞苷的摄入之间存在时间关联。事实上，在开始每7天一个周期的阿扎胞苷治疗后的2 - 3天，他报告血糖水平升高，需要增加自我注射胰岛素的剂量。
这一观察结果有助于理解这两种疾病的病理生理学，并可能促使医生对有糖尿病史且正在接受低甲基化药物治疗的患者监测血糖水平。
