CLASSIFICATION OF CHILDREN WITH NEWLY DIAGNOSED DIABETES MELLITUS

Purpose (a): Historically the diagnosis of Type 2 Diabetes Mellitus (T2DM) has relied on a well described clinical phenotype. The reliability of this clinical phenotype in classifying children with diabetes is, however, not clear. The ability of experienced clinicians to correctly classify the type of diabetes based upon the clinical phenotype has recently been challenged. According to the American Diabetes Association, the diagnosis of T2DM requires a fasting plasma glucose of 126 mg/dL or higher, a 2-hour glucose level of 200 mg/dl or higher during a 75-g oral glucose tolerance test, or a random plasma glucose of 200 mg/dL or higher in a patient with classic symptoms of hyperglycemia or hyperglycemia crisis. In addition, those with T2DM should demonstrate the absence of diabetes auto-antibodies. Since the appropriate classification of a child's diabetes has important implications with regard to treatment options, expected outcomes and genetic counseling, a systematic, cost-effective algorithm to assist in the initial classification of diabetes mellitus is needed. Methods (b): We propose a retrospective analysis of diabetes related autoantibody tests (GAD, IA-2, Tg, Gliadin Peptide IGA, Gliadin Peptide IGG) in children (< 18 yrs of age) seen for evaluation of newly diagnosed diabetes mellitus in the Pediatric Endocrine Clinic hospitalized at Cook Children’s Medical Center for Jan 2010-June 2012.Following IRB approval, children and adolescents. Results (c): Following IRB approval, we conducted a retrospective chart review of 348 children(178 males; 170 females) hospitalized at Cook’s Children’s Medical Center from Jan 2010 – Jun 2012 with new onset diabetes mellitus to determine the frequency of antibody positive vs. antibody negative diabetes mellitus. In addition the frequency and test results for other diabetes-associated conditions (i.e. thyroid and celiac disease) were summarized. As expected the majority of patients were positive for one or more diabetes related antibodies. A much smaller number of patients were also tested for diabetes-associated conditions. Conclusions (d): We conclude that the majority of children < 18 years of age with new onset diabetes are positive for diabetes antibodies at the time of presentation. Those that are antibody negative need further evaluation to 1) determine whether these patients may have T2DM, a genetic form of DM (i.e. MODY) or some other form of diabetes and 2) to provide appropriate therapeutic and genetic counseling. Given the complexity of diagnosing diabetes mellitus and the rising cost of healthcare, a systematic algorithm may be useful in providing a cost-effective means of classifying children with new onset diabetes mellitus.