Hormone research in paediatrics · 2026
Incidence of Pediatric Hyperglycemic Hyperosmolar State: A Prospective National Surveillance Study.
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Ryan Paul M, Sellers Elizabeth A C, Amed Shazhan, Hamilton Jill
Аннотация
INTRODUCTION: Hyperglycemic hyperosmolar state (HHS) is a severe diabetic emergency, typically seen in adults with type 2 diabetes, but with high morbidity described in the limited pediatric cases available in the literature. Existing estimates of pediatric HHS incidence are primarily derived from administrative datasets and may be affected by diagnostic misclassification. We sought to determine the minimum incidence, clinical characteristics, management, and outcomes of pediatric HHS.
METHODS: Approximately 2,700 pediatricians and pediatric subspecialists were surveyed monthly from June 2023 through May 2025 to identify cases of pediatric HHS, via the Canadian Paediatric Surveillance Program. Cases were adjudicated using predefined biochemical criteria, including severe hyperglycemia, elevated serum osmolality (>320 mOsm/kg), and absence of significant acidosis. Detailed clinical data were collected for confirmed cases.
RESULTS: Twenty-four cases were reported during the 24-month surveillance period. Following case adjudication, seven cases met diagnostic criteria for HHS, corresponding to a minimum annual incidence of 0.059 cases per 100,000 child-years (95% CI 0.024-0.122). Median age at presentation was 14.8 years, and all cases occurred in individuals with newly diagnosed or previously unrecognized diabetes. Common precipitating factors included infection, trauma, and surgery. Most patients required intensive care admission, with a median hospital stay of six days. Frequent complications included acute kidney injury and hypokalemia, and one patient required intervention for suspected cerebral injury, although no deaths were reported. Half of initially reported cases were subsequently reclassified as hyperosmolar diabetic ketoacidosis, highlighting challenges in the recognition and classification of pediatric hyperglycemic emergencies.
CONCLUSION: National surveillance in Canada identified lower incidence of HHS, indicating that prior estimates based on administrative data likely overstate rates due to misclassification of hyperglycemic emergencies.
METHODS: Approximately 2,700 pediatricians and pediatric subspecialists were surveyed monthly from June 2023 through May 2025 to identify cases of pediatric HHS, via the Canadian Paediatric Surveillance Program. Cases were adjudicated using predefined biochemical criteria, including severe hyperglycemia, elevated serum osmolality (>320 mOsm/kg), and absence of significant acidosis. Detailed clinical data were collected for confirmed cases.
RESULTS: Twenty-four cases were reported during the 24-month surveillance period. Following case adjudication, seven cases met diagnostic criteria for HHS, corresponding to a minimum annual incidence of 0.059 cases per 100,000 child-years (95% CI 0.024-0.122). Median age at presentation was 14.8 years, and all cases occurred in individuals with newly diagnosed or previously unrecognized diabetes. Common precipitating factors included infection, trauma, and surgery. Most patients required intensive care admission, with a median hospital stay of six days. Frequent complications included acute kidney injury and hypokalemia, and one patient required intervention for suspected cerebral injury, although no deaths were reported. Half of initially reported cases were subsequently reclassified as hyperosmolar diabetic ketoacidosis, highlighting challenges in the recognition and classification of pediatric hyperglycemic emergencies.
CONCLUSION: National surveillance in Canada identified lower incidence of HHS, indicating that prior estimates based on administrative data likely overstate rates due to misclassification of hyperglycemic emergencies.