Stress hyperglycemia in pediatric patients as a risk factor for type 1 diabetes - a single center experience

Objectives: Stress hyperglycemia is relatively common in the pediatric emergency department. It is usually associated with severe illnesses such as infections, seizures, and trauma. The association between stress hyperglycemia and future development of type 1 diabetes mellitus is unclear. Different reports have shown controversial results. Methods: This was a retrospective follow-up cohort of children admitted to the pediatric emergency department at the Shaare Zedek Medical Center in Jerusalem, Israel during the years 2010-2014 with stress hyperglycemia. The study group was then evaluated over a 10-year period for developing type 1 diabetes mellitus. The study group incidence was then compared to the general population. Results: During the study period, there were 1,184 admissions with stress hyperglycemia. The most common diagnoses were infectious (36.5%) and respiratory (24.3%) diseases. There were two cases that later developed type 1 diabetes. This resulted in an odds ratio of 14.95 for developing type 1 diabetes in the study cohort (with fatalities removed) compared to the known incidence in Israel at that time (95% CI, (p<0.01)). Conclusions: Children presenting with stress hyperglycemia may be at greater risk for developing type 1 diabetes and should warrant close follow-up and possibly advanced testing to offer early diagnosis.