Diabetes During Diarrhea-Associated Hemolytic Uremic Syndrome

Abstract

OBJECTIVE -To quantify the incidence of diabetes during the acute phase of diarrheaassociated hemolytic uremic syndrome (DϩHUS) and to identify features associated with its development. RESEARCH DESIGN AND METHODS-A systematic review and meta-analysis of articles assessing diabetes during DϩHUS was conducted. Relevant citations were identified from Medline, Embase, and Institute for Scientific Information Citation Index databases. Bibliographies of relevant articles were hand searched. All articles were independently reviewed for inclusion and data abstraction by two authors.RESULTS -Twenty-one studies from six countries were included. Only 2 studies reported a standard definition of diabetes; 14 defined diabetes as hyperglycemia requiring insulin. The incidence of diabetes during the acute phase of DϩHUS could be quantified in a subset of 1,139 children from 13 studies (1966 -1998, age 0.2-16 years) and ranged from 0 to 15%, with a pooled incidence of 3.2% (95% CI 1.3-5.1, random-effects model, significant heterogeneity among studies, P ϭ 0.007). Children who developed diabetes were more likely to have severe disease (e.g., presence of coma or seizures, need for dialysis) and had higher mortality than those without diabetes. Twenty-three percent of those who developed diabetes acutely died, and 38% of survivors required long-term insulin (median follow-up 12 months). Recurrence of diabetes was possible up to 60 months after initial recovery.CONCLUSIONS -Children with DϩHUS should be observed for diabetes during their acute illness. Consideration should be given to long-term screening of DϩHUS survivors for diabetes. Diabetes Care 28:2556 -2562, 2005H emolytic uremic syndrome (HUS) is characterized by acute hemolytic anemia, thrombocytopenia, and renal failure (1). The incidence of HUS is estimated at 1 per 50,000 person-years for children Ͻ18 years of age (2). Over 90% of childhood cases are associated with diarrhea and gastroenteritis due to Shiga toxin-producing Escherichia coli O157:H7 (3). Also known as "typical" or "primary" HUS, diarrhea-associated HUS (DϩHUS) causes toxin-mediated endothelial cell damage, resulting in thrombotic microangiopathy and intraluminal thrombosis of small vessels, with subsequent tissue ischemia and necrosis (4). Although renal and central nervous system involvement predominate, the pancreas can be affected, causing acute diabetes. Autopsy studies have demonstrated thrombosis of vessels supplying the islets of Langerhans with preservation of the exocrine pancreas (5,6). Although renal complications of HUS have received much attention (7), little is known about the incidence and management of diabetes during DϩHUS. Using techniques described by Stroup et al. (8), this systematic review was conducted to better understand diabetes associated with DϩHUS. RESEARCH DESIGN AND METHODS Research questionsThe primary research questions were as follows. 1) What is the incidence of diabetes during acute DϩHUS? 2) Is diabetes during acute DϩHUS associated with more severe DϩHUS, as defined ...

Childhood hemolytic uremic syndrome is associated with adolescent-onset diabetes mellitus

“…Hyperglycemia occurs in 1-6% of HUS cases [4,7] with a pooled estimate of 3.2% [9]. These patients generally have severe disease and are more likely to manifest central nervous system complications, have more days of anuria, require more days of dialysis, or succumb to their disease [4,7].…”

“…The question remains regarding the need for long-term screening for glucose metabolism derangements among HUS survivors [9]. Other case reports [6,8] of presumed transient hyperglycemia suggest that glucose monitoring continue for a period of time after the resolution of hyperglycemia.…”

Recurrence of Diabetes After Diarrhea-Associated Hemolytic Uremic Syndrome

“…It is useful to follow such cases to elucidate fulminant type 1 diabetes etiology, and further study is required to clarify its entity. (1). In this article, we find a systematic review and meta-analysis of articles assessing diabetes during diarrhea-associated hemolytic uremic syndrome (DϩHUS).…”

A gradient of acute gastroenteritis was characterized, to assess risk of long-term health sequelae after drinking bacterial-contaminated water

“…Individuals were eligible for study participation if they lived in the Walkerton area or had consumed municipal water in May 2000, whether or not they had developed an acute illness. The Walkerton Health Study provides a unique opportunity to characterize new and existing epidemiological associations between acute bacterial gastroenteritis and chronic diseases, including postinfectious irritable bowel syndrome, arthritis, hypertension, renal disease, and diabetes mellitus [5][6][7][8][9][10][11]. Additionally, any psychosocial sequelae of this stressful environmental disaster, as well as health care utilization after the outbreak, may be better characterized [12,13].…”