Background: Type 2 diabetes is a heterogeneous disorder characterized by the defective of insulin, which can not progressively compensate for insulin resistance, due to the influence of environmental factors on the basis of genetic susceptibility. Hyperglycemia, which starts with insulin resistance, is thought to show toxic effects (glucotoxicity) on β cells and ultimately impairs beta cell function., Although many factors play a role in etiology, obesity is the most common cause. Type 2 diabetes is more common in girls than boys. In this article, we present etiology and clinical features of type 2 diabetic cases followed-up in our clinic, and share treatment and follow-up approaches.
Cases: A total of 16 patients (12 female, 4 male) with type 2 diabetes mellitus who admitted to our clinic were included this study. The causes of admission, family history, hormonal and biochemical evaluation, and the treatments were recorded for all patients. 37.5% of patients had presented with typical symptoms of diabetes and one of the patients presented with severe symptoms such as hyperosmolar nonketotic coma, 12.5% applied with infection symptoms (stress hyperglycemia) and other patients were asymptomatic. One patient referred with cataract. The family history was positive in 11 patients and all patients were obese and/or overweight except for one patient. Acanthosis was also detected in half of the patients. Approximately 70% of patients require insulin treatment.
Conclusion: Type 2 diabetes is an insidious disease and rare in children. Because of this, the diagnosis can be delayed. Here we discussed the cases of heterogeneous clinically confronted type 2 diabetes: two cases of hyperosmolar nonketotic coma, one with diabetic ketoacidosis, one with ketosis, one with cataract, and 8 asymptomatic patients. Family history was positive for majority of children and type 2 diabetes was especially associated with obesity. In spite of heavy insulin resistance, acanthosis was seen in half of the patients, which is another case showing clinical heterogeneity in the patients. In conclusion, in children with obesity, especially if there is family history, type 2 diabetes should be considered even in absence of clinical symptoms.
27 - 29 Sep 2018
European Society for Paediatric Endocrinology