The recognition of chemical diabetes mellitus in children has led to questions of diagnostic criteria, methodology of testing, choice of populations to study and possible therapeutic approaches to the prevention of progression to overt (insulin-dependent) diabetes. Since the natural history of chemical diabetes in children includes spontaneous improvement as well as stability or progression of glucose intolerance, evaluation of the significance of abnormality and the effect of potential therapy is difficult. The oral glucose tolerance test (OGTT), despite problems in interpretation and methodology, remains the only generally accepted test for chemical diabetes in children. Criteria for interpretation of the OGTT in children used by pediatric investigators are similar to the Fajans and Conn standards for adults. Application of these criteria to certain high risk groups, including obese children, children with mild symptoms suggestive of hypoglycemia, and siblings of those with overt diabetes, has permitted the identification of 200 children with this stage of diabetes. Approximately 11 per cent have progressed to insulin dependency during one to seventeen years of observation. Data on treatment of these patients is limited to anecdotal reports or summaries of small groups of patients treated for variable periods with sulfonylurea drugs. It is not possible to recommend a therapeutic program for children with chemical diabetes, except in the case of the overweight child, where diet restriction may be as efficacious as in adults. Thus, testing of high risk persons and attempts at treatment should only be undertaken in an investigational setting.

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