DISTINCTION BETWEEN TRANSIENT HYPERGLYCEMIA AND EARLY INSULIN-DEPENDENT DIABETES-MELLITUS IN CHILDHOOD - A PROSPECTIVE-STUDY OF INCIDENCE AND PROGNOSTIC FACTORS

We prospectively studied 63 children with transient hyperglycemia to d etermine their risk of acquiring insulin-dependent diabetes mellitus ( IDDM) and to evaluate the predictive value of immunologic markers of p rediabetes and of the intravenous glucose tolerance test. Children wit h transient hyperglycemia were identified by a prospective systematic review of the laboratory reports of a large children's hospital and an office-based pediatric practice and by referral from pediatricians. T ransient hyperglycemia occurred in 0.46% of children seen in the child ren's hospital and in 0.013% of children attending a pediatric office practice. Insulin-dependent diabetes mellitus developed within 18 mont hs of identification in 32% of children in whom transient hyperglycemi a was discovered in the absence of a serious illness, compared with 2. 3% of children identified during a serious illness (relative risk, 13. 9; 95% confidence interval, 1.56 to 123.5). Islet cell antibodies and competitive insulin autoantibodies each had a 100% positive predictive value for IDDM; the negative predictive value of islet cell antibodie s and competitive insulin autoantibodies was 96% and 98%, respectively . The stimulated insulin release during an intravenous glucose toleran ce test, adjusted for age, had the highest overall accuracy of predict ion. All children less than 6 years of age with stimulated insulin rel ease levels <85 pmol/L (12 muU/ml) subsequently had IDDM, as did an 11 -year-old child whose stimulated insulin release level was below the l st percentile of 170 pmol/L (24 muU/ml). To date, no child whose stimu lated insulin release level was above the 5th percentile has had IDDM. We conclude that when transient hyperglycemia occurs during a serious intercurrent illness, the risk of progression to IDDM is low. In cont rast, one third of children in whom transient hyperglycemia is identif ied without a serious illness can be expected to have IDDM within 1 ye ar. A combination of islet cell antibodies, competitive insulin autoan tibodies, and stimulated insulin release levels during an intravenous glucose tolerance test can accurately distinguish children with predia betes from those with presumed benign transient increases in plasma gl ucose concentrations.