Background: Metformin (dimethylbiguanide) is the most widely prescribed treatment for children with T2DM. Long term controlled studies are still required to assess its effect on prediabetes dysglycemia in children
Case presentation: A 13-year-old lean adolescent girl presented to PEC with a day history of difficult breathing associated with dry cough. No history of fever, abdominal pain, vomiting or change in bowel motion. She had a 10 months history of excessive water drinking and polyuria and mild weight loss. She had a family history of bronchial asthma and T2DM (both parents families). Examination revealed: RR=34/min, HR=123b/min, BP 130/80 mmHg, BMI 20 kg/m2. She did not have acanthosis nigricans or goiter. The diagnosis of atypical pneumonia was entertained and treated. Lab showed hyperglycemia, BG=16.2 mmol/L, PH=7.35, HCO3=19.7 mmol/L. Repeated lab revealed: Blood glucose (BG) 28.5 mmol/L, PH 7.19, HCO3=11 mmol/L and PCO2=28.7 mmol/L. She was started on insulin infusion therapy and IV Fluid therapy as per DKA protocol. Further labs showed HbA1C=5.7%, plasma insulin=239 uU/mL (High), C-peptide=14.68 ng/mL (High). Acidosis and glycemia was corrected in 12 hours. Follow up of her BG readings for 3 days, without insulin therapy, were: (Before breakfast =(5.16.1 mmol/L), before lunch (5.27.2 mmol/L) and before dinner (5.58.9 mmol/L). SBGM showed postprandial hyperglycemia (7.79.4 mmol/L). OGTT (using 75 g Dextrose) showed fasting BG=5.4 mmol/L, and 2hrs BG=7.9 mmol/L with fasting insulin level=15.2mU/mL. HOMA-IR was 3.7. Anti-GAD antibodies were undetectable. Continuous glucose monitoring (CGMS) tracing showed glucose peaks up to 11.7 mmol/L 1hour after meals. 18% of the time her glucose was > 7.8 mmol/L and 82% between 3.97.8 mmol/L. Metformin 500mg BID was prescribed with lunch and dinner. The table shows the average (mean) of her BG (mg/dl) readings by glucometer before versus after Metformin therapy.The mean BG readings decreased by a mean of =1.1 mmol/L (20 mg/dl) after Metformin therapy.
|Mean BG||Fasting||B- lunch||A- 2 h*||B- dinner||A- 2 h|
|*After Metformin 500 mg dose. B= before, A- = after.|
Conclusion: Metformin successfully corrected dysglycemia in a lean adolescents with prediabetes.
27 - 29 Sep 2018
European Society for Paediatric Endocrinology