Prediabetic markers in children with stress hyperglycemia

Area of Science:

• Pediatric Endocrinology
• Immunology
• Genetics

Background:

• Previous research linked stress hyperglycemia in children to an increased risk of developing type 1 diabetes (insulin-dependent diabetes mellitus).
• The potential for stress hyperglycemia to indicate a prediabetic state in pediatric patients required further investigation.

Purpose of the Study:

• To determine if stress hyperglycemia in prospectively screened pediatric patients signifies a prediabetic state.
• To investigate the presence of immunologic and genetic markers associated with type 1 diabetes in hyperglycemic children.

Main Methods:

• A prospective cohort study screened pediatric patients for hyperglycemia (blood glucose ≥ 8.3 mmol/L).
• Hyperglycemic patients were age-matched with stress control (acutely ill, non-hyperglycemic) and healthy control subjects.
• Blood samples were analyzed for islet cell antibodies, insulin autoantibodies, GAD antibodies, and HLA-DQB1 genotypes.

Main Results:

• No patients or controls tested positive for islet cell antibodies.
• Insulin autoantibodies were found in four subjects with sickle-cell disease and fever, but not in others.
• No increased prevalence of diabetes-associated HLA-DQB1 genotypes was observed in the hyperglycemic group.
• Follow-up at 31–36 months showed no development of type 1 diabetes in any group.

Conclusions:

• Children experiencing stress hyperglycemia do not exhibit a higher prevalence of immunologic or genetic markers for type 1 diabetes.
• The findings suggest that stress hyperglycemia in children is unlikely to be a prediabetic state.
• Insulin autoantibodies may develop in children experiencing sickle cell crises.