1976 Volume 19 Issue 1 Pages 9-21
In order to screen for asymptomatic kidney disease, the first morning urine specimens obtained in the morning were collected from over 220, 000 school children in Tokyo prefecture. These urine specimens were also tested for asymptomatic diabetes. The percentage of positive glucosuria in junior high school pupils (0.25%, 159/63130) was higher than in elementary school pupils (0.12%, 188/157492). All children whose first specimen showed a positive glucosuria were recalled and a further specimen was collected. Forty of 177 pupils in elementary school and 48 of 149 pupils in junior high school in whom the second specimen contained significant glucose were referred to the hospital clinic. In 74 of 88 pupils with persistent glucosuria, tolerance to glucose was investigated by giving 50g of glucose after an overnight fast. Blood samples were drawn at 0, 30, 60, 90, 120, and 180 min. during the oral glucose tolerance test and analyzed for sugar by the Somogyi-Nelson method. Of the 74 children, 44 had entirely normal glucose responses to oral glucose administration while 9 (5 pupils in elementary school and 4 in junior high school) were diabetic by the United States Public Health Service (USPHS) criteria. Three subjects were classified as diabetes suspects according this criteria. In our screening program the incidence of asymptomatic diabetes in school children was approximately 0.052%.
Urinary glucose screening of school children has been felt to be an unsound practice because children with chemical diabetes mellitus will not have glucosuria, and those destined to develop overt diabetes over the next year would largely be missed. Chemical diabetes must be screened by the test for glucosuria one hour following an oral glucose load. According to this procedure, most glucosuria discovered will be non-diabetic and the cost yield ratio might be extremely high.
There can be, however, no argument that early detection of overt diabetes before the development of severe ketoacidosis makes for easier entry into a control program. A child with asymptomatic overt diabetes must be detected by the glucose test on first urine specimen obtained in the morning which had accumulated in the bladder from 3 to 12 hours following the last meal. It is now clear that our multiphasic urine screening tests for asymptomatic diabetes mellitus and kidney diseases in school children are most feasible, effective and economical.
