Stress hyperglycemia in children with family history of diabetes may be first sign of diabetes

Oron T. Pediatrics. 2011;doi:10.1542/peds.2010-3193.

Researchers in Israel found that stress hyperglycemia during early childhood in those who have a positive family history for diabetes may be the first sign of the disease.

The researchers reported the cases of two boys who presented to the ED for febrile infection. The first boy was 2.7 years old and had no symptoms of diabetes, but routine blood tests showed hyperglycemia. After IV fluids, his HbA1c level decreased to a normal level. His mother had a history of gestational diabetes.

The second boy was 5 days old. His premeal HbA1c levels were elevated and associated with constant glycosuria. The glycosuria disappeared by discharge, but his HbA1c levels remained elevated. The infant was further evaluated for diabetes. His mother had a history of gestational diabetes, and other maternal family members also had a history of diabetes.

Because of the family histories, blood glucose monitoring at home was recommended. In both cases, there were persistent elevated blood glucose levels, even after the disappearance of the stress event. This fact, combined with the family history of diabetes and the stress hyperglycemia, were suggestive of monogenic diabetes.

Genetic analysis was performed. In the 2.7-year-old boy, the researchers found the mutation c.697T>C p.C233R. In the 5-day-old boy, the researchers found the mutation c.616A>C p.T206P. There were no additional mutations found in the GCK gene.

“Primary care providers should be aware of the connection between stress hyperglycemia and a positive family history of diabetes,” the researchers wrote. “Our patients had the specific elements of family history and clinical presentation that enabled us to identify them as being at risk for monogenic diabetes.”

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