Introduction: The incidence of type 1 and type 2 diabetes mellitus in children and adolescent has been on the rise for the last decades. While the reasons behind these are not known, one possible explanation for the emergence of type 2 diabetes in children is the increase of obesity and decreasing physical activity. Adolescents are at the cross roads between childhood and adulthood and that makes classification of their diabetes mellitus at presentation a diagnostic challenge.
Objectives/Aims: To describe the clinical presentation, diagnosis and management of an obese adolescent boy who was newly diagnosed with diabetes mellitus and to categorize it according the current standard classifications.
Method/Case: We present a 16 years old boy who first presented to the emergency department with dizzy spells and lethargy after school. Upon rapid assessment in the emergency department, he was noted to have the following features; obesity with body mass index (BMI) of 32 kg/m2, acanthosis nigricans in the nape of the neck and arm pits, gynaecomastia but no abdominal striae, moon face or buffalo hump. He was noted to have dehydration, elevated blood glucose, with readings of 17 mmol/L and positive urine ketones. A diagnosis of diabetes ketoacidosis (DKA) was made and he was treated in accordance with the standard protocol. Following the resolution of DKA, he was discharged home on vildagliptin/metformin. However, he was admitted 3 days later in a state of DKA. Following that admission, a possibility of type 1 diabetes mellitus in was entertained and the c-peptide and the auto-antibody screen was done.
Results: His blood investigations revealed the following: the C-Peptide; 455 pmol/L (normal range 3641655 pmol/L), HbA1c of 12.1%, Anti-glutamic acid Decarboxylase (GAD) Antibody >2000 IU/mL(Positive)(normal range 010 IU/mL), Islet cell Antibody (pancreas IFA)-positive, Anti-IA2 Antibody <10.00 IU/ ml (Normal Range 020 IU/mL), Gluten IgE-Negative (<0.10) KU/L (Normal Range 010 KU/L), Gluten IgA (anti gliadin)-0.40 U/ml (Normal Range 010 U/mL)
Discussion/Conclusion: In view of obesity, acanthosis nigrans and normal C-Peptide levels, type 2 diabetes mellitus was initially considered. Positive auto-antibodies and failure of oral hypoglycaemics makes type 1 diabetes mellitus likely in that obese adolescent. We conclude that classification of diabetes mellitus in obese adolescents is challenging and clinicians should consider all possibilities at diagnosis.
27 - 29 Sep 2018
European Society for Paediatric Endocrinology