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Published on: January 7, 2018
Insights
Three children with insulin-dependent diabetes mellitus (IDDM) developed insulin resistance (IR). Two cases involved high insulin antibodies, while one had hyperthyroidism, highlighting diverse causes of IR in pediatric diabetes.
Area of Science:
- Pediatric Endocrinology
- Metabolic Disorders
- Immunology
Background:
- Insulin resistance (IR) is a complex condition impacting glycemic control in children with insulin-dependent diabetes mellitus (IDDM).
- Understanding the diverse etiologies and clinical presentations of IR is crucial for effective management in pediatric populations.
Observation:
- A review of 1000 children with IDDM identified three cases of new-onset insulin resistance.
- One patient with IDDM and cystic fibrosis, and another typical IDDM patient, presented with high insulin antibody titers and responded to sulfated insulin.
- A third patient with IDDM and hyperthyroidism showed IR controlled by propylthiouracil, despite high anti-insulin antibodies.
Findings:
- Among 29 reported children with IDDM and IR, 71% had elevated insulin antibodies.
- Associated illnesses were present in 41% of these pediatric patients.
- Outcomes varied, with 67% improving, 21% persisting with IR, and 12% mortality.
Implications:
- This study underscores the importance of investigating underlying causes for IR in children with IDDM, including autoimmune responses and comorbid conditions.
- Early identification and tailored treatment strategies are essential for managing IR and improving outcomes in pediatric diabetes.
- The findings contribute to the limited literature on insulin resistance in children, particularly highlighting rare associations like cystic fibrosis and hyperthyroidism.
Abstract:
In a review of the 1000 children with insulin-dependent diabetes mellitus (IDDM) followed at The Hospital for Sick Children, Toronto, between 1970 and 1980, insulin resistance (IR) was noted in 3 after initial sensitivity to exogenous insulin. One was an otherwise typical patient with IDDM. One had cystic fibrosis and is the first such patient with IR to be reported. These two had high insulin antibody titers and responded dramatically to sulfated insulin. The third patient had hyperthyroidism. Although she also had a high anti-insulin antibody titer, IR was controlled only when she was given propylthiouracil. She is the first reported child with IR and hyperthyroidism. The literature on IR in children with IDDM is reviewed. With our 3 patients included, a total of 29 children have been reported. Their mean age is 12.9 yr, 72% are female, and 41% had associated illnesses. Insulin antibodies were elevated in 71% of those in whom measurement was attempted. Of those whose outcome is reported, 67% improved, 21% continued to have IR, and 12% died.
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