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Non-insulin dependent diabetes mellitus in Mexican-American children
1Department of Pediatrics, University of California (UC), Davis, School of Medicine, Sacramento 95817, USA. fzglaser@ucdavis.edu
Insights
Non-insulin-dependent diabetes mellitus (NIDDM) in children is characterized by obesity, acanthosis nigricans, and a strong family history, particularly in Mexican-American youth. Early identification through insulin secretion testing is crucial for appropriate management.
Area of Science:
- Pediatric Endocrinology
- Metabolic Disorders
- Diabetes Mellitus Research
Background:
- Non-insulin-dependent diabetes mellitus (NIDDM) is increasingly recognized in pediatric populations.
- Understanding the distinct clinical and metabolic profiles of pediatric NIDDM is essential for accurate diagnosis and management.
- Previous studies have highlighted the heterogeneity of diabetes in children, necessitating specific characterization of NIDDM subtypes.
Purpose of the Study:
- To define the clinical and metabolic characteristics of children and adolescents diagnosed with non-insulin-dependent diabetes mellitus (NIDDM).
- To identify key features that suggest NIDDM in pediatric patients, differentiating them from insulin-dependent diabetes mellitus.
- To evaluate the prevalence of NIDDM within pediatric diabetes clinics, particularly among specific ethnic groups.
Main Methods:
- Retrospective review of medical records for 18 children and adolescents meeting NIDDM diagnostic criteria.
- Inclusion criteria: evidence of sustained endogenous insulin secretion and glycemic control with diet or oral agents for over 2 years.
- Exclusion criteria: presence of islet cell antibodies or insulin autoantibodies; assessment of clinical features, metabolic markers, and family history.
Main Results:
- NIDDM represented 8% of all pediatric diabetes cases and 19% of those in Central/South American ancestry; 67% of the study group were Mexican American.
- Common findings included obesity (67%) and acanthosis nigricans (89%); mean age of onset was 12.8 years.
- A strong family history of NIDDM was present in 87% of patients, with 47% having affected 3+ generations; mean fasting C-peptide was 1.19 nmol/L.
Conclusions:
- Pediatric NIDDM is a distinct subset of childhood diabetes, often presenting without ketoacidosis but with acanthosis nigricans, obesity, and a significant family history.
- Mexican-American children with these clinical features are particularly susceptible to NIDDM.
- Testing for endogenous insulin secretion is recommended for diabetic children exhibiting these characteristics to ensure appropriate therapeutic strategies.
Abstract:
To define the clinical and metabolic characteristics of children with non-insulin-dependent diabetes mellitus (NIDDM), we reviewed the medical records of 18 children and adolescents who met either or both of the following criteria for the diagnosis of the disease: evidence of continued endogenous secretion of insulin beyond that expected in insulin-dependent diabetes mellitus and satisfactory glycemic control with diet alone or in combination with an oral hypoglycemic agent more than 2 years from the time of diagnosis. Patients who met these criteria but had islet cell antibodies or insulin autoantibodies were eliminated from the study group. Patients with NIDDM constituted 8% of all patients with diabetes seen in our pediatric clinics and 19% of diabetic patients of Central or South American ancestry. Of the 18 patients, 12 (67%) were Mexican American. The mean age of onset was 12.8 years (range, 5 to 17). Obesity (n = 9) and acanthosis nigricans (n = 12) were common findings. Ketonuria was present at diagnosis in 5 (33%) of 15 patients and acidosis in 2 of 14 (14%). Challenge with a nutritional supplement (Sustacal, Mead Johnson Nutritionals) (n = 10) showed a mean fasting serum C-peptide concentration of 1.19 nmol per liter (3.6 ng per ml). A family history of NIDDM was present in 13 (87%) of 15 patients, with 7 (47%) having 3 or more generations affected. Children with NIDDM are an important subset of those with diabetes, and this disease should be suspected in diabetic children presenting without ketoacidosis and with acanthosis nigricans, obesity, and a strong family history, particularly among those of Mexican-American ethnicity. Children with these characteristics should undergo testing of endogenous insulin secretion for appropriate therapeutic intervention.