J Korean Med Sci.  2017 Jun;32(6):985-991. 10.3346/jkms.2017.32.6.985.

Urinary Glucose Screening for Early Detection of Asymptomatic Type 2 Diabetes in Jeonbuk Province Korean Schoolchildren

• Kim MS
• Lee DY

• KMID: 2377729
• DOI: http://doi.org/10.3346/jkms.2017.32.6.985

Abstract

This study aimed to investigate the prevalence of glucosuria and the characteristics of diabetes in schoolchildren as detected by a school urine glucose screening program implemented from 2010 to 2013 in the Jeonbuk province area of Korea. A total of 110 children without known diabetes were analyzed. They were checked with an oral glucose tolerance test (OGTT) with other laboratory tests and their clinical data were collected. A total of 707,238 schoolchildren from a school population of 1,064,999 were screened for glucosuria. In total, over a 4-year period, 545 schoolchildren (0.077%) were positive for glucosuria on the second urine test. The prevalence of glucosuria was more common among middle and high schoolchildren than among elementary schoolchildren. Among 110 students who completed the OGTT to confirm diabetes, 40 were diagnosed with diabetes mellitus (DM); 39 children, type 2 diabetes mellitus (T2DM) and 1 child, slowly progressive insulin dependent diabetes mellitus (SPIDDM). The mean annual incidence of diabetes was 5.6 per 100,000 schoolchildren and adolescents. The subjects with diabetes diagnosed through the urine screening test showed minimal or no symptoms of diabetes. The students with diabetes were more likely to be woman and obese, and they have a higher body mass index, higher cholesterol, triglyceride, insulin, C-peptide, and fasting glucosuria values than the students with normal glucose tolerance. We identified 40 new cases of diabetes in the Korean schoolchildren with asymptomatic glucosuria on urine glucose screening. This finding shows that school urine glucose screening is a feasible and simple method for early detection of asymptomatic T2DM.

Keyword

Urine Screening; Glucosuria; School; Children; Diabetes

MeSH Terms

Adolescent
Body Mass Index
C-Peptide
Child
Cholesterol
Diabetes Mellitus
Diabetes Mellitus, Type 2
Fasting
Female
Glucose Tolerance Test
Glucose*
Humans
Incidence
Insulin
Jeollabuk-do*
Korea
Mass Screening*
Methods
Prevalence
Triglycerides
C-Peptide
Cholesterol
Glucose
Insulin

Reference

1. Daneman D. Type 1 diabetes. Lancet. 2006; 367:847–858.

2. Gungor N, Hannon T, Libman I, Bacha F, Arslanian S. Type 2 diabetes mellitus in youth: the complete picture to date. Pediatr Clin North Am. 2005; 52:1579–1609.

3. Harron KL, Feltbower RG, McKinney PA, Bodansky HJ, Campbell FM, Parslow RC. Rising rates of all types of diabetes in south Asian and non-south Asian children and young people aged 0-29 years in West Yorkshire, U.K., 1991–2006. Diabetes Care. 2011; 34:652–654.

4. Type 2 diabetes in children and adolescents. American Diabetes Association. Pediatrics. 2000; 105:671–680.

5. Copeland KC, Silverstein J, Moore KR, Prazar GE, Raymer T, Shiffman RN, Springer SC, Thaker VV, Anderson M, Spann SJ, et al. Management of newly diagnosed type 2 Diabetes Mellitus (T2DM) in children and adolescents. Pediatrics. 2013; 131:364–382.

6. Committee on Practice and Ambulatory Medicine, Bright Futures Steering Committee. Recommendations for preventive pediatric health care. Pediatrics. 2007; 120:1376.

7. Urakami T, Kubota S, Nitadori Y, Harada K, Owada M, Kitagawa T. Annual incidence and clinical characteristics of type 2 diabetes in children as detected by urine glucose screening in the Tokyo metropolitan area. Diabetes Care. 2005; 28:1876–1881.

8. Urakami T, Owada M, Kitagawa T. Recent trend toward decrease in the incidence of childhood type 2 diabetes in Tokyo. Diabetes Care. 2006; 29:2176–2177.

9. Wei JN, Chuang LM, Lin CC, Chiang CC, Lin RS, Sung FC. Childhood diabetes identified in mass urine screening program in Taiwan, 1993–1999. Diabetes Res Clin Pract. 2003; 59:201–206.

10. Cho BS, Hahn WH, Cheong HI, Lim I, Ko CW, Kim SY, Lee DY, Ha TS, Suh JS. A nationwide study of mass urine screening tests on Korean school children and implications for chronic kidney disease management. Clin Exp Nephrol. 2013; 17:205–210.

11. . . []. Korean School Health Association. The annual incidence of urinary abnormalities in Korean school children(2007–2011) [Internet]. accessed on 15 October 2016. Available at www.ksha.or.kr.

12. Moon JS, Lee SY, Nam CM, Choi JM, Choe BK, Seo JW, Oh K, Jang MJ, Hwang SS, Yoo MH, et al. 2007 Korean National Growth Charts: review of developmental process and an outlook. Korean J Pediatr. 2008; 51:1–25.

13. Alberti KG, Zimmet PZ. Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med. 1998; 15:539–553.

14. Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia. 1985; 28:412–419.

15. Lawrence RD. Symptomless glycosurias; differentiation by sugar tolerance tests. Med Clin North Am. 1947; 31:289–297.

16. Urakami T, Morimoto S, Nitadori Y, Harada K, Owada M, Kitagawa T. Urine glucose screening program at schools in Japan to detect children with diabetes and its outcome-incidence and clinical characteristics of childhood type 2 diabetes in Japan. Pediatr Res. 2007; 61:141–145.

17. Urakami T, Miyamoto Y, Fujita H, Kitagawa T. Type 1 (insulin-dependent) diabetes in Japanese children is not a uniform disease. Diabetologia. 1989; 32:312–315.

18. Turner R, Stratton I, Horton V, Manley S, Zimmet P, Mackay IR, Shattock M, Bottazzo GF, Holman R. UKPDS 25: autoantibodies to islet-cell cytoplasm and glutamic acid decarboxylase for prediction of insulin requirement in type 2 diabetes. UK Prospective Diabetes Study Group. Lancet. 1997; 350:1288–1293.

19. Lee SA, Lee WJ, Kim EH, Yu JH, Jung CH, Koh EH, Kim MS, Park JY, Lee KU. Progression to insulin deficiency in Korean patients with Type 2 diabetes mellitus positive for anti-GAD antibody. Diabet Med. 2011; 28:319–324.

20. Kong YH, Kim MS, Lee DY. Comparison of the prevalence of islet autoantibodies according to age and disease duration in patients with type 1 diabetes mellitus. Ann Pediatr Endocrinol Metab. 2013; 18:65–70.

21. Kim MS, Yu KY, Na JI, Kim JD, Lee OK, Lee DY. The changes of incidence of childhood diabetes in Jeollabuk-do for 26 years. J Korean Soc Pediatr Endocrinol. 2008; 13:29–35.

22. Berenson GS, Srinivasan SR, Bao W, Newman WP 3rd, Tracy RE, Wattigney WA. Association between multiple cardiovascular risk factors and atherosclerosis in children and young adults. The Bogalusa Heart Study. N Engl J Med. 1998; 338:1650–1656.

23. Jang M, Berry D. Overweight, obesity, and metabolic syndrome in adults and children in South Korea: a review of the literature. Clin Nurs Res. 2011; 20:276–291.

24. Park MJ, Boston BA, Oh M, Jee SH. Prevalence and trends of metabolic syndrome among Korean adolescents: from the Korean NHANES survey, 1998-2005. J Pediatr. 2009; 155:529–534.

25. . . . []. Korean Educational Development Institute. 2013 Korea School Health Examination Survey [Internet]. accessed on 8 November 2016. Available at https://www.kedi.re.kr/khome/main/research/selectPubForm.do?plNum0=9602.

26. West KM, Kalbfleisch JM. Sensitivity and specificity of five screening tests for diabetes in ten countries. Diabetes. 1971; 20:289–296.

27. Friderichsen B, Maunsbach M. Glycosuric tests should not be employed in population screenings for NIDDM. J Public Health Med. 1997; 19:55–60.