Non-Diabetic Hyperglycemia in the Pediatric Age: Why, How, and When to Treat?
- 111 Downloads
Purpose of review
Non-diabetic hyperglycemia (NDHY) is a pathological condition that is not yet well known. The aim of this review is to examine approaches for management of this condition.
While it is well known that persistent hyperglycemia in diabetes affects immune response and risk for diabetes-related micro- and macrovascular complications, little is known about the biological effects of transient NDHY, particularly in the pediatric age group.
Stress HY (SHY) is typically defined as blood glucose > 8.33 mmol/L (150 mg/dL) during physical stress, resolving spontaneously after dissipation of acute illness in patients without known diabetes. Based on the literature and clinical practice, two situations can be classified: (1) SHY1, which occurs during severe and prolonged illness and under serious life-threatening conditions, mainly in emergency situations and in resuscitation areas; and (2) SHY2, which occurs during acute illness, mainly in non-life-threatening conditions. Furthermore, (NDHY) among pediatric patients can be induced by drugs; the most frequent conditions are secondary to (1) steroid therapy and (2) antineoplastic/immunosuppressive therapy.
KeywordsNon-diabetic hyperglycemia Stress hyperglycemia Drug-induced hyperglycemia Management
Compliance with Ethical Standards
Conflict of Interest
Valentina Fattorusso, Rosa Nugnes, Alberto Casertano, Giuliana Valerio, Enza Mozzillo, and Adriana Franzese declare that they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by the any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 5.Yung M, Wilkins B, Norton L, Slater A. Paediatric Study Group; Australian and New Zealand Intensive Care Society. Glucose control, organ failure, and mortality in pediatric intensive care. Pediatr Crit Care Med. 2008;9(2):147–52. https://doi.org/10.1097/PCC.0b013e3181668c22.CrossRefPubMedGoogle Scholar
- 6.Hirshberg E, Larsen G, Van Duker H. Alterations in glucose homeostasis in the pediatric intensive care unit: Hyperglycemia and glucose variability are associated with increased mortality and morbidity. Pediatr Crit Care Med. 2008;9(4):361–6. https://doi.org/10.1097/PCC.0b013e318172d401.CrossRefPubMedGoogle Scholar
- 14.•• Vanhorebeek GJ, Van den Berghe G. Critical Care Management of Stress-Induced Hyperglycemia. Current Diabetes Reports. 2018;18:17. https://doi.org/10.1007/s11892-018-0988-2. This paper compares studies debating the efficacy and safety of tight glycemic control in critically ill patients and proposes strategies for safer glucose control.
- 17.Mobaireek KF, Alsheri A, Alsadoun A, Alsamari A, Alashhab A, Alrumaih M, et al. Hyperglycemia in children hospitalized with acute asthma. Adv Exp Med Biol. 2018. https://doi.org/10.1007/5584_2018_152.
- 33.• Arians G, De Jong S, Gietema J, et al. Cancer-drug induced insulin resistance: innocent bystander or unusual suspect. Cancer Treat Rev. 2015;41(4):376–84. https://doi.org/10.1016/j.ctrv.2015.02.007. This paper discusses the pathogenesis of hyperglycemia induced by antineoplastic drugs and suggests treatment strategies. CrossRefGoogle Scholar
- 40.Dhital SM, Shenker Y, Meredith M, et al. A retrospective study comparing neutral protamine Hagedorn insulin with glargine as basal therapy in prednisone-associated diabetes mellitus in hospitalized patients. Endocr Pract. 2012;18(5):712–9. https://doi.org/10.4158/EP11371.OR.CrossRefPubMedPubMedCentralGoogle Scholar