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Editor,—In 1968 Milunsky and Neurath reported an increased prevalence of diabetes mellitus in patients with Down’s syndrome.1 However, the response rate in their survey was low (<50%) and the authors did not distinguish between insulin and non-insulin dependent diabetes mellitus. In 1973, Jeremiahet al also reported an increased prevalence of diabetes mellitus in Down’s syndrome patients.2 Their observations, however, were based on the presence of glucosuria.
In the second Dutch nationwide study on the incidence of diabetes mellitus type I in children,3 five cases of Down’s syndrome in the age range of 0–14 years were spontaneously reported. Taken into account a yearly incidence of 250 newborns with Down’s syndrome, this results in an incidence of diabetes mellitus in Down’s syndrome of 50/100 000/year (95% confidence interval (CI) 16 to 116/100 000/year), whereas in the general population the incidence during the same period was 12.4/100 000/year (95% CI 12.1 to 12.7/100 000/year). These data suggest a threefold increased risk of diabetes mellitus in children with Down’s syndrome. We also estimated the prevalence in a population based study among 893 children with Down’s syndrome aged 0–9 years born between 1986 and 1994. Three of them had diabetes mellitus, giving a prevalence rate of 335/100 000 (95% CI 87 to 980/100 000), which is higher than the prevalence of diabetes mellitus type I in the age matched general population (40/100 000; 95% CI 35 to 45/100 000).
Our data confirm the suspicion that children with Down’s syndrome are more prone to develop diabetes mellitus. All children were insulin dependent. However, it remains to be investigated whether these patients have type I or type II diabetes mellitus as both autoimmunity and signs of premature aging in Down’s syndrome could predispose towards type I and type II diabetes mellitus.4 As the symptoms of diabetes mellitus in Down’s syndrome children may be more difficult to detect and there is an increased risk of complications such as hyperosmolar coma,5 special attention has to be taken to symptoms as polydipsia and polyuria.