Non-insulin-dependent diabetes mellitus in Indian children in Manitoba

Abstract

Objective: To report on our 7-year experience with non-insulin-dependent diabetes mellitus (NIDDM) in native Indian children in Manitoba and to raise the awareness of physicians about the difficulties in the classification and management of hyperglycemia in Indian children.

Design: Case series.

Patients: All Indian children under 15 years of age referred for evaluation and management of diabetes to the diabetes clinic at the Children's Hospital of Winnipeg between 1984 and 1990 who did not have a history of diabetic ketoacidosis.

Main results: Sixteen girls and four boys aged 7 to 14 years at the time of diagnosis were identified as having NIDDM. All 16 children whose family history could be confirmed had at least one parent with NIDDM. Five of the 20 complained of polyuria or nocturia; the remainder presented with asymptomatic glycosuria. At the time of diagnosis the random serum glucose level varied from 15.0 to 30.8 mmol/L, the fasting serum insulin level from 45 to 300 pmol/L and the total glycated hemoglobin level from 7.1% to 23.3%. Twelve of the children had been followed for at least 4 years. Six of the 12 had received insulin therapy at some time, including during pregnancy. At the time of writing, none was receiving therapy with insulin or orally given hypoglycemic drugs. All were encouraged to follow a weight-reduction diet and exercise regimen. During follow-up the mean total glycated hemoglobin level for each patient varied from 9.1% to 20.9%; none maintained a glycated hemoglobin level in the normal range.

Conclusions: NIDDM occurs in Indian children under 15 years of age. The clinical features at presentation occasionally mimic those of insulin-dependent diabetes. A strong family history of NIDDM and lack of diabetic ketoacidosis during follow-up support the diagnosis of NIDDM. Adherence to a diet and exercise regimen has been poor. The conventional diabetes education approach may not be appropriate for this population.