Prevalence of type 2 diabetes in egyptian children and adolescents : (pilot study)‎

Abstract EN

Background : Incidence and prevalence of type2 diabetes in children and adolescents are increasing worldwide with variable susceptibility between different ethnic groups.

Obesity is a well-recognized risk factor, and early detection and management are important to prevent the development of complications of chronic undiagnosed hyperglycemia.

Aim : To identify whether type2 diabetes or non-diabetic hyperglycemia [impaired fasting glucose (IFG) and / or impaired glucose tolerance (IGT)] could be an undiagnosed medical condition in obese Egyptian children and adolescents; and to study the risk factors related to the development of hyperglycemia, if present.

Subjects and Methods : Fifty obese children and adolescents, from the Diabetic Endocrine and Metabolic Pediatric Unit (DEMPU) at Children's Hospital of Cairo University, were screened for type2 diabetes.

They included 19 males and 31 females, with mean age 11.6 +2.1 years, and with weight and BMI > 95th ccntile.

After full hisloiy taking and thorough examination, each case was screened, after an overnight fast of at least 8 hours by: fasting blood gucose, fasting serum insulin and C-peptide in the same sample, 2-hours post-prandial blood UCOse after a standard meal containing at least 1.75g / kg glucose with max 75g, as well as Sycated hemoglobin (HbAi).

Fasting serum lipids including total cholesterol, LDL, HDL and ycendes were also done after an overnight fast.

Fasting blood glucose levels in the gycemic range (> 110 mg / dl) were repeated on another visit for confirmation.

Screening revealed elevated fasting C-peptide, indicating hyperinsulinemia, in 29 °), where 14 had elevated C-peptide alone, another 8 had associated elevation of Ve, and another 4 had elevated glycated hemoglobin as well.

Three other cases had elevated C- peptide and HbAl with normal insulin.

Two pubertal females, 14 and 12 yrs., had j blood glucose levels in the diabetic range (129 and 137 mg / dl) and one pubertal 10 yrs boy had I impaired fasting glucose (IFG, HOmg / dl).

Another pubertal boy had impaired glucose tolerance (IGT, 160 mg / dl) with normal fasting glucose and C-peptide.

Positive family history of diabetes was recorded in these 4 cases.

Further 3 cases had high HbAl (>7.8 %) with other glycemic indices normal.

All screened cases had at least one form of dyslipidemia and 74 % had raised systolic and / or diastolic blood pressure.

Conclusion : Obese Egyptian children and adolescents are at risk of hyperglycemia and type2 diabetes, especially with puberty and in the presence of positive family history of diabetes.

Fasting blood glucose test yielded more positive results than the 2hrs postprandial test, and thus is convenient for screening.

Glycated hemoglobin might point to others at risk with impaired glucose tolerance, but needs further evaluation.

Screening will allow focusing on those with impaired fasting glucose, and thus at risk of type2 diabetes, and will allow early diagnosis and intervention with prevention of complications.