Abstract Ref Number = APCP163
Screening for childhood type 2 diabetes
Department of Pediatrics, Nihon University School of Medicine, Tokyo, Japan
The incidence of childhood type 2 diabetes is increasing worldwide, including not only Asian countries butEuropean countriesand USA. The diagnostic criteria of type 2 diabetes include obesity, clinical signs of insulin resistant such as acanthosis nigricans and family history of type 2 diabetes among relatives in the first- and second-degrees. In contrastto type 1 diabetes, type 2 diabetes is characterized by showing mild or minimum symptoms of diabetes at diagnosis. Therefore, some cases can be found by anincidental examinationat hospital or a screening program in the absence of symptom of diabetes. Candidates to be screened may be individuals with asymptomatic or minor symptoms, obesity (BMI above 85-90thcentile), a positive family history of type 2 diabetes and existence of factors in metabolic syndrome such as hyperlipidemia, liver dysfunction and hypertension.
On the other hand, Japan has a unique screening program to detect diabetes in school children by using the urine glucose test. Since 1974,all primary and junior high schoolstudents, 6-15 years of age, have been screened for glucosuria concomitant with proteinuria and hematuria, aimed to diagnose chronic kidney disease at the early stage. The urinalysis is conducted using glucose oxidase strips by testing a morning urine specimen. When the urine test is positive for glucose (≥50 mg/dL of glucose), a subsequent urine test is requested on another morning. An oral glucose tolerance test 1.75 g/kg∙body weight of glucose, maximum 75 g) is performed when a positive result is obtained in both the initial and subsequent urine tests to confirm the diagnosis of diabetes.As the results of the screening in the Tokyo Metropolitan Area during the period from 1974 to 2010, the overall incidence of type 2 diabetes (per 100,000/year) was 2.58 in all students, 0.80 in primary school students, aged 7-12 years, and 6.41 in junior high school students, aged 12-15 years. We found increasing trend in the overall incidence of school students with type 2 diabetes from 1975 to 1982, but adecreased tendency in recent years. Lifestyle changes in recent years might contribute to improved incidence of childhood type 2 diabetes in Japan.
Screening program at schools may beuseful to detect childhood type 2 diabetes at the early stage of diabetes and to prevent progression of diabetes by early intervention. It can be also effective to decrease in the incidence of childhood type 2 diabetes by educating risks of developing disease to students and their families.