Stress hyperglycemia in childhood: A very high risk group for the development of type I diabetes

Vardi, Pnina; Shehade, Naim; Etzioni, A; Herskovits, Tomi; Soloveizik, Lea; Shmuel, Zehava; Golan, D; Barzilai, D; Benderly, A

doi:10.1016/s0022-3476(05)82447-3

Cited by 28 publications

(11 citation statements)

References 8 publications

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“…16,17 In our study, a quarter of patients experienced a subsequent episode of transient hyperglycemia. However, no patients were diagnosed with type 1 or 2 DM on follow-up, although 1 patient did develop corticosteroid-induced diabetes and remained insulin dependent.…”

Section: Discussionmentioning

confidence: 54%

Extreme Stress Hyperglycemia During Acute Illness in a Pediatric Emergency Department

Weiss

Alexander

Agus

2010

Pediatric Emergency Care

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Objectives Although mild stress hyperglycemia in pediatric illness is common, severe hyperglycemic responses (≥300 mg/dL [16.7 mmol/L]) to stress are unusual. We sought to determine the incidence and course of extreme stress hyperglycemia (ESH) in acute pediatric illness, including whether it is a marker of increased mortality or associated with subsequent development of diabetes mellitus (DM). Methods We retrospectively reviewed a cohort of 55,120 consecutive visits over 6 years to a pediatric emergency department at which blood glucose concentrations were measured and report on visits with laboratory glucose 300 mg/dL (16.7 mmol/L) or greater without DM. Results There were 72 cases of ESH (incidence of 0.13%). Median age was 8.8 years; 63% were male. The most common diagnoses were respiratory illness (49%), trauma (15%), and seizure (8%), and 65% of patients had received glucose-influencing interventions before evaluation. Eighty-five percent were ill appearing, 60% were admitted to the intensive care unit, and half had acidemic pH values. The overall mortality rate was 22%. Despite treatment of hyperglycemia in only 8 patients, glucose concentrations decreased to 150 mg/dL (8.3 mmol/L) or less within 48 hours in 67% and before discharge or death in 85% of patients. Preceding symptoms and concurrent laboratory results were helpful to exclude diabetes, and none of the surviving patients with follow-up available went on to develop type 1 or 2 DM. Conclusions Although rare, ESH (≥300 mg/dL [16.7 mmol/L]) does occur in acute pediatric illness, in most cases is at least partially iatrogenic, and is a marker of severe illness and high mortality. Normoglycemia is typically restored quickly with treatment of the primary illness. No association was found with a subsequent diagnosis of DM.

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Section: Discussionmentioning

confidence: 54%

Extreme Stress Hyperglycemia During Acute Illness in a Pediatric Emergency Department

Weiss

Alexander

Agus

2010

Pediatric Emergency Care

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“…175 The reported incidence of progression to overt diabetes varies from 0% to 32%. 174,[176][177][178][179][180][181] Children with incidental hyperglycemia without a serious concomitant illness were more likely to develop diabetes than those with a serious illness. 179 As would be expected, testing for diabetes associated autoantibodies had a high positive and negative predictive value for the development of type 1 diabetes in children with stress hyperglycemia.…”

Section: Stress Hyperglycemiamentioning

confidence: 99%

ISPAD Clinical Practice Consensus Guidelines 2018: Definition, epidemiology, and classification of diabetes in children and adolescents

et al. 2018

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“…The reported incidence of progression to overt diabetes varies from 0 to 32% (145,(147)(148)(149)(150)(151)(152). Children with incidental hyperglycemia without a serious concomitant illness were more likely to develop diabetes than those with a serious illness (150).…”

Section: Stress Hyperglycemiamentioning

confidence: 99%

Definition, epidemiology, and classification of diabetes in children and adolescents

et al. 2014

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Stress hyperglycemia in childhood: A very high risk group for the development of type I diabetes

Cited by 28 publications

References 8 publications

Extreme Stress Hyperglycemia During Acute Illness in a Pediatric Emergency Department

Extreme Stress Hyperglycemia During Acute Illness in a Pediatric Emergency Department

ISPAD Clinical Practice Consensus Guidelines 2018: Definition, epidemiology, and classification of diabetes in children and adolescents

Definition, epidemiology, and classification of diabetes in children and adolescents

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