Table 2 Summary of studies on the relationship between stress hyperglycemia and diabetes mellitus
From: Stress hyperglycemia as first sign of asymptomatic type 1 diabetes: an instructive case
Study | Numbers/Age/Country | Analysis and Results | SH association with DM | Strength | Limitation |
|---|---|---|---|---|---|
Our case | A boy with AEBA 8 yrs Taiwan | Case report Analyze the SH pattern by regular stick blood glucose test Evaluate HbA1C, glucagon test, insulin Ab, urinalysis | Subclinical T1DM is associated with ESH (> 300 mg/dL), high glucose variability (△BG > 150 mg/dL), prolonged hyperglycemic duration (> 48 h) and ketonuria | Offer unique hints of lactent DM during SH Delicate evaluation of T1DM (HbA1C, glucagon test, insulin Ab) Evaluate glucose variability | Case report |
Gupta et al. 1997 [2] | 758 ill children 1 m/o to 6 yrs. Delhi, India | Cross-sectional study SH defined as ≥150 mg/dL SH prevalence: 4.7% (36/758) All SH resolved within 24 h from admission No significant association between SH and severity of illness | OGTT were performed in 31 SH subjects and all revealed normal results Urinalysis were performed in 30 SH subjects and no ketonuria was found | Large population-based Using OGTT to confirm DM | Exclude subjects with beta 2 agonist and steroid Tx Without insulin Ab evaluation |
Bhisitkul et al. 1994 [3] | 926 ill children 3 days to 21 yrs. Norfolk,Virginia | Cross-sectional and longitudinal study SH defined as ≥150 mg/dL SH prevalence: 3.8% (35/926) SH is associated with severity such as high fever, ICU admission, and intravenous hydration | No SH subjects were diagnosed with DM | Large population-based Cross-sectional and longitudinal (mean f/u 4 to 9 m/o) | Exclude subjects with beta 2 agonist and steroid Tx |
Shehadeh et al. 1997 [6] | 36 ill children 1 to 17 yrs. Haifa, Israel | Longitudinal study SH defined as ≥150 mg/dL No subject was diagnosed with DM | SH is a low risk factor of T1DM | Longitudinal analysis (mean f/u 3.2 yrs) Evaluation of T1DM (serum Ab, IVGTT) | Small population-based No asthmatic subject No control group |
Herskowitz-Dumont et al. 1993 [7] | 63 children with transient hyperglycemia 1 to 18 yrs. Boston, Massachusetts | Longitudinal study Hyperglycemia defined as ≥150 mg/dL 19 healthy subjects; 44 with illness (11 asthmatic subjects) 32% (6/19) healthy subjects and 2.3% (1/44) ill subjects were diagnosed with T1DM | Transient hyperglycemia is a high risk to develop T1DM in healthy subjects, but a low risk in ill subjects No asthmatic subject developed T1DM | Longitudinal analysis (mean f/u 7 yrs) Evaluation of T1DM (serum Ab, IVGTT) Enrolled asthmatic subjects | Small population-based No control group |
Eshraghi et al. 2014 [8] | 50 children with history of SH Average 9.8 yrs. Babol, Iran | Retrospective cohort study SH defined as ≥200 mg/dL No subjects were diagnosed with DM Insulin resistance in 16% (8/50) subjects | SH is a low risk factor of T1DM but may be related to Insulin resistance | Evaluation of T1DM (serum Ab, OGTT) | Small population-based Exclude subjects with beta 2 agonist and steroid Tx |
Bhisitkul et al. 1996 [9] | 30 ill children with SH, 30 ill children without SH, 30 healthy subjects 4 weeks to 12.4 yrs. Norfolk, Virginia | Case-control and longitudinal study SH defined as ≥150 mg/dL No subjects were diagnosed with DM | SH is a low risk factor of T1DM | Longitudinal analysis (mean f/u 31 to 36 m/o) Evaluation of T1DM (serum Ab) Compared with two control goups | Exclude subjects with beta 2 agonist and steroid Tx No asthmatic subject |
Weiss et al. 2010 [10] | 55,120 ill children including 72 ESH subjects Average 8.8 yrs. (ESH subject) Boston, Massachusetts | Retrospective cohort study ESH defined as ≥300 mg/dL ESH prevalence: 0.13% (72/55120) Asthmatic children account for 31% (22/72) ESH subjects ESH is associated with increased mortality and severity of illness Only one subject was diagnosed with steroid induced DM | No asthmatic subject developed T1DM or T2DM No association between ESH and DM Urinalysis was performed in 53% (38/72) ESH subjects and ketonuria was found in 13% of them | Large population-based Enrolled asthmatic subjects Include subjects with β2 agonist and steroid Tx | No control group |
Jin-Sun Chang et al. 2013 [11] | Mice with diabetes (animal model) | Animal study Analyze the SH pattern of diabetic mice under predator stress (cat) Distinct SH pattern among different types of DM | T1DM exhibited the “fast & slow” pattern during SH | Describe glucose fluctuation | Not human model Psychiatric stress may be different from physiological stress |