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Stress hyperglycemia and the risk for the development of type 1 diabetes
1Department of Pediatrics, Rambam Medical Center, Poriya Hospital, Haifa, Israel.
Insights
Transient hyperglycemia in children during illness is a minimal risk factor for future diabetes. Most children evaluated showed normal endocrine function and did not develop diabetes.
Area of Science:
- Pediatric Endocrinology
- Metabolic Disorders
- Immunology
Background:
- Transient hyperglycemia during acute illness may indicate early beta cell dysfunction.
- Identifying markers for prediabetes in such cases is crucial.
Purpose of the Study:
- To characterize stress hyperglycemia in children.
- To determine the prevalence of prediabetes markers.
Main Methods:
- Studied 36 children referred for hyperglycemia during illness.
- Assessed immunologic markers (autoantibodies) and first-phase insulin secretion via IVGTT.
Main Results:
- No patients had islet cell autoantibodies.
- Eight patients had impaired first-phase insulin response; 3 had insulin autoantibodies.
- All children normalized within 12-16 months; none developed diabetes.
Conclusions:
- Stress hyperglycemia in children without other risk factors poses minimal risk for future diabetes.
- Transient beta cell dysfunction during illness appears reversible in most cases.
Abstract:
Transient hyperglycemia during acute illness may represent the earliest clinical sign of impaired beta cell function. This study sought to characterize the clinical presentation of patients with stress hyperglycemia and to determine the prevalence of immunologic and endocrinologic markers associated with prediabetes. Thirty-six children were studied. They were referred to us for routine evaluation after an episode of hyperglycemia during severe intercurrent illness. Immunologic markers (insulin autoantibodies and islet cell autoantibodies) and intravenous glucose tolerance test for evaluation of first phase insulin secretion rate were performed in all participants. Islet cell autoantibodies were negative in all patients. In eight patients, the first phase insulin response was below the first percentile (46 microU/ml) at the first determination. Insulin autoantibodies were positive in another three children (> 60 nU/ml). Twelve to sixteen months later, all children were re-evaluated and all had normal results. None of the patients developed diabetes during the study (mean 3.2 years). Our data support the idea that episodes of hyperglycemia during severe illness without additional risk factors are a minimal risk factor, if any, for future development of IDDM.