Academic journal article Journal of Health Population and Nutrition

Clinical Characteristics of Non-Insulin-Dependent Diabetes Mellitus among Southwestern American Indian Youths

Academic journal article Journal of Health Population and Nutrition

Clinical Characteristics of Non-Insulin-Dependent Diabetes Mellitus among Southwestern American Indian Youths

Article excerpt


Diabetes mellitus is divided into insulin-dependent diabetes mellitus (IDDM) and non-insulin-dependent diabetes mellitus (NIDDM). Insulin-dependent mellitus is caused by autoimmune islet cell destruction and the resultant insulinopaenia (1). The pathophysiologic processes in NIDDM are the topic of debate and extensive research, but both increased insulin resistance and decreased insulin secretion are involved (2).

Although IDDM is the most common form of diabetes to present in childhood, it is not the only one. A subtype of NIDDM that occurs during youth is referred to as maturity onset diabetes of youth (MODY) and is inherited in an autosomal dominant pattern (1). A form of 'atypical diabetes' has been described among black youths who present with acute diabetic symptoms and insulin dependence, but subsequently undergo spontaneous remission and appear to have NIDDM (3,4).

American Indians, like other US minorities, have low rates of IDDM compared to the white population (5,6). Many American Indian tribes have a high prevalence of diabetes (7). This paper describes the clinical characteristics of American Indian youths who presented with NIDDM at or before 20 years of age.


The Tohono O'odham Nation of southwest Arizona receives the majority of their medical care through the Indian Health Service (IHS) at the Sells Hospital. This tribe has a very high prevalence of NIDDM. Medical records obtained through the IHS indicate that, in 19851986, 18% of the population over age 17 had diabetes (8).

For this study, the medical records of 22 patients who received medical care at the Sells IHS facilities prior to spring of 1991 were reviewed. Patients were identified either through regularly scheduled diabetic clinics, paediatric clinics, or using the computerized patient information system. Chart reviews for this study were undertaken during the late spring and early summer of 1991. Criteria for inclusion in the review were the diagnosis of diabetes mellitus prior to this time frame with an onset at age 20 years or less (excluding gestational diabetes) and a blood quantum that was one half or greater of Tohono O'odham. The charts of the parents were then reviewed to ascertain any history of diabetes as well as information regarding the mothers' prenatal course.

Body mass index (BMI) was computed based on the weight and height of the patients at diagnosis. For those few cases where height was not available, BMI was imputed using the 95 percentile of height-for-age on standard growth charts. Laboratory results obtained during the patients' diabetic care were also reviewed. Blood glucose values reflect either plasma glucose determinations or glucometer readings recorded by the laboratory on site at the IHS facility. Ten of the patients had C-peptide levels drawn, and these were non-fasting levels drawn at clinic visits and analyzed at a reference laboratory using Incstar RIA kits.


Twenty-two patients were identified as having diabetes mellitus that was diagnosed before the age of 21 years. The clinical characteristics of these patients are summarized in Table 1. The average age of onset was 13.7 years (range: 7-20 years), and the mean duration of the disease was 3.6 years (range: 1-11 years). There was no significant difference in age of onset or duration of disease between the 10 males and 12 females.

Clinical presentation

The clinical presentation of diabetes was variable. Nine patients were diagnosed when elevated blood sugars were found during the course of medical examinations for school or other health problems. Symptoms of insulin deficiency, such as nocturia, polyuria, or weight loss, were mild or absent in these patients. Eleven patients presented with symptoms suggestive of diabetes, including polyuria, nocturia, enuresis, weight loss, fatigue, or recurrent skin infections. One patient presented with diabetic ketoacidosis (DKA) with a concurrent streptococcal pneumonia. …

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