Abstract 518 Endocrinology I Poster Symposium, Saturday, 5/1

Over the past 6 years, we have experienced a major increase in the number of referrals for children with non-insulin dependent diabetes. At initial visit, mean age was 13.5 years. Almost all were Mexican American (MA) (84%), pubertal (87%) and obese (95%). Because there are few data on Type 2 diabetes in youth, we undertook a pilot study in 3 middle schools (grades 6, 7, and 8; age range 11 -14 years) in southwest San Antonio to evaluate the prevalence of Type 2 diabetes risk factors in this population. The students were urban, MA (98%) with family incomes <200% of the poverty level (86%).

In a group of 1498 students, 474 gave consent. Each family answered a risk factor questionnaire. The child was weighed, measured, blood pressure taken and neck examined for acanthosis nigricans (AN). Of the children, there was a strong family history of diabetes (54%), hypertension, (48%), hyperlipidemia (40%), early (< 50 years of age) myocardial infarction (11%) and sudden nontraumatic death (8%). Obesity (body mass index > 90% for age) was common in both females (27%) and males (40%). AN (> Grade 2) was present in 19%, with no sex difference, while hypertension (BP > 95% for age and sex) was more common in males (15%) than in females (3%). After obtaining a separate consent, a fasting blood specimen was obtained on 97 youth for glucose, insulin, HgB A1C and lipid profile. Lipid abnormalities were present in 49%. Insulin levels were elevated in 26% and correlated strongly with BMI (p < 0.0001) and AN (p < 0.0001). Eight (8%) children had fasting glucose > 110 mg/dl and one (1%) had diabetes (fasting glucose > 126 mg/dl).

This small pilot project suggests that poor MA children are at significant risk for developing diabetes due to the high prevalence of obesity and insulin resistance in this population. A large comprehensive screening program for diabetes risk is warranted in the pediatric population, especially among minorities. Previous population based screening have excluded children. This may not be appropriate in view of our pilot data.