Until recently, almost all diabetes (DM) in children was presumed to be secondary to autoimmune islet cell destruction (Type 1); however, recent studies in at-risk minorities (African-American, Native American) suggest that there may be an increasing number of youth with DM resulting from insulin resistance. As a first step in determining if a similar trend is occuring in the Hispanic population, we have reviewed all patients identified with DM since 1990. To be classified as having DM, a fasting laboratory glucose>140 mg% or a postprandial glucose >200 mg% was required. To be classified as non-insulin dependent, a patient also had to have an elevated fasting insulin and/or C-peptide, be in overall good health, and be on no hyperglycemic agents (e.g. steroids).
Of 560 patients with DM, 101 (18%) were identified with Type 2Y. During the 7 years reviewed, new Type 1 cases have remained constant (50 ±5), while new Type 2Y cases have increased from 1 case in 1990 to more than 30 cases in 1997. Type 2 patients had a mean age of 13.9 years (range 6-18) at presentation. They are predominantely Hispanic (83%) and female (75%). Almost all have a parent or grandparent with Type 2 diabetes. The initial complaint ranged widely (obesity, lethargy, recurrent vaginal yeast infections) and symptoms had been present for 3 weeks to 2 years. The majority were obese (82% with BMI> 27.5 kg/m2) although 40% were reported to have lost weight (3-90 kg). Acanthosis nigricans was present in 92% of the patients, with the most common site being the posterior neck. Pubertal status was Tanner stage 5 in 58%, stages 2-4 in 30% and stage 1 in 12%. At diagnosis, glucose ranged from 140-1120 mg%, pH ranged from 7.21 - 7.46, HCO3- from 11-28 meq/L. Almost all(88%) Type 2Y had an elevated Hgb A1C at diagnosis.
Non-insulin dependent diabetes has been considered to be a disease of adults; therefore, DM screening programs have consistently excluded children and adolescents. Our data suggest that 1) noninsulin dependent DM occurs in youth and 2) may be increasing in the pediatric population, especially among minorities, as has recently been reported in Arkansas (Pediatr 100:84, 1997) and Ohio (J Pediatr 128:608, 1996). There is a compelling need for a well-planned population-based screening study for non-insulin dependent DM in at-risk pediatric populations.