PREDIABETIC MARKERS IN CHILDREN WITH STRESS HYPERGLYCEMIA

Background: Previous studies have shown that children with stress hype rglycemia have an increased risk for development of type I or insulin- dependent diabetes mellitus. Objective: To determine whether stress hy perglycemia in prospectively screened pediatric patients represents a prediabetic state. Design: Prospective, cohort analytic study. setting : The Children's Hospital of the King's Daughters is an urban pediatri c emergency department at a tertiary care, university-based children's hospital in Norfolk, Va. Patient Population: All patients who require d a venipuncture for evaluation of an acute illness or injury from Oct ober 1992 through March 1993 were screened prospectively for hyperglyc emia (blood glucose level greater than or equal to 8.3 mmo/L [greater than or equal to 150 mg/dL]). Each hyperglycemic patient was age match ed to a stress control subject (defined as a nonhyperglycemic but acut elyill child) from the emergency department and a healthy control subj ect from a well-child clinic. Intervention: Blood samples were obtaine d at the time of initial evaluation in the emergency department from 3 0 hyperglycemic patients (age range, 4 weeks to 12.4 years; median, 2 years), 30 stress control subjects, and 30 healthy control subjects. A ll samples were tested for islet cell antibodies, insulin autoantibodi es, glutamic acid decarboxylase (GAD) antibodies, and HLA typing, spec ifically the genotypes at the DQB1 gene. Main Outcome Measures: The pr esence of immunologic or genetic markers for insulin-dependent diabete s mellitus and/or the clinical development of insulin-dependent diabet es mellitus. Results: No patients or control subjects were positive fo r islet cell antibodies. One hyperglycemic patient and 3 stress contro l subjects were positive for insulin autoantibodies; all 4 of these su bjects had sickle-cell disease and fever. Four of the 8 patients with sickle cell disease had insulin autoantibodies, compared with none of the 52 patients and stress control subjects without sickle-cell diseas e (P<.001). One healthy control subject had antibodies to GAD(65). The patient group did not show increased genotypes at the DQB1 gene that were indicative of an enhanced risk for insulin-dependent diabetes mel litus. Of the 32 hyperglycemic patients, 27 healthy control subjects, and 25 stress control subjects contacted for follow-up at 31 to 36 mon ths, none has developed insulin-dependent diabetes mellitus. Conclusio ns: Children with stress hyperglycemia do not have an increased preval ence of immunologic or genetic markers of insulin-dependent diabetes m ellitus and thus do not appear to be at an increased risk for developm ent of insulin-dependent diabetes mellitus. Our data suggest that insu lin autoantibodies develop in children subject to sickle cell crises.