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Transient hyperglycemia in childhood: identification of a subgroup with imminent diabetes mellitus

R D Herskowitz1, J I Wolfsdorf, A T Ricker

  • 1Joslin Diabetes Center, Children's Hospital, Harvard Medical School, Boston, Massachusetts 02215.

Diabetes Research (Edinburgh, Scotland)
|December 1, 1988
PubMed

Insights

Transient hyperglycemia in children can signal early Type 1 diabetes (T1D). Immunological markers and impaired insulin secretion during glucose tests strongly predict T1D development, aiding early intervention.

Area of Science:

  • Endocrinology
  • Pediatrics
  • Immunology

Background:

  • Transient hyperglycemia is an early indicator of Insulin-Dependent Diabetes Mellitus (IDDM).
  • Predicting IDDM development in children with hyperglycemia is crucial for timely intervention.

Purpose of the Study:

  • To evaluate the predictive accuracy of various tests for impending IDDM in children with transient hyperglycemia.
  • To identify the most reliable markers for predicting IDDM development.

Main Methods:

  • Prospective study of 30 children with transient hyperglycemia.
  • Assessment included oral glucose tolerance tests (OGTT), intravenous glucose tolerance tests (IVGTT) measuring "K rate" and first-phase insulin secretion, and immunological markers (islet cell antibodies, insulin autoantibodies).

Main Results:

  • 27% of children developed IDDM within 10 months.
  • Immunological abnormalities (islet cell antibodies/insulin autoantibodies) had the highest positive predictive value.
  • Impaired first-phase insulin secretion during IVGTT showed the highest negative predictive value and overall accuracy.
  • Oral glucose tolerance tests were less accurate predictors.

Conclusions:

  • Immunological markers and impaired insulin secretion are strong predictors of IDDM in children with transient hyperglycemia.
  • First-phase insulin secretion during IVGTT is the most accurate predictor for identifying children at high risk for IDDM.

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