Studies on the Natural History of Asymptomatic Diabetes in School Children

Abstract

The carbohydrate metabolism was studied in 6 of 9 school children with asymptomatic diabetes detected by the multiphasic urine screening program which tested more than 220, 000 pupils in 1974. Two diabetic children, aged 15 years and with weights 122-204% standard weight, were classified as group A. Four children, aged 6-13 years and with weights 76-100% standard weight, were classified as group B.
The oral 50g glucose tolerance test and the 20mg/kg tolbutamide tolerance test were performed; venous blood being obtained at 0, 15, 30, 60, 90, 120 and 180 minuted for estimation of blood glucose and plasma insulin. In addition to these tests, the 0.1 u/kg regular insulin tolerance test was performed; blood samples being obtained at 0, 30, 60, 90, and 120 minutes for estimation of blood glucose and plasma growth hormone.
In the diabetic children of group A and B, the insulin responses to glucose were subnormal, but a slight decrease in blood glucose level associated with a 2.0 to 2.5 fold increase in plasma insulin level during the intravenous tolbutamide load was observed in group A. Blood glucose during the insulin sensitivity test fell to 15-36 per cent of the fasting level in group B, while it fell to only 60-65 per cent of the fasting level in group A. Serum cholesterol, but not serum triglyceride was significantly higher in 3 of 4 children in group B, while serum triglyceride and pre-beta lipoprotein were elevated in all children of group A. Six patients with asymptomatic diabetes have been followed for 12 months. Only one patient, aged 9, in group B has developed insulin dependent diabetes mellitus, but the insulin response in the other patients of group B has not deteriorated over the 12 month period. In the patients of group A. significant insulin responses to glucose were observed after the treatment of obesity with diet. Normal glucose tolerance was obtained in one of the obese diabetic children after the treatment.
It has been reported that the course of diabetes in children is characterized by a rapid and progressive decrease in insulin reserves. However, from our results, it was recognized that the carbohydrate intolerance of asymptomatic diabetes mellitus in school children may show little or no progression in severity over several months. Such a slow progression of asymptomatic diabetes in many children suggests that mass-screening in school children is e ffective in the detection of diabetes and consideration of prophylactic measures may be possible.