ESPE Abstracts (2018) 89 RFC3.6

Treatment Adherence and Weight Loss are Key Predictors of HbA1c One Year after Diagnosis of Childhood Type 2 Diabetes in UK

Toby Candlera,b, Osama Mahmoudc,d, Richard Lynne, Abdalmonem Majbara, Timothy Barrettf & Julian PH Shielda

aNIHR Biomedical Research Centre: Nutrition, Diet and Lifestyle theme, Bristol, UK; bMRC The Gambia at LSHTM, Fajara, Gambia; cPopulation Health Sciences, University of Bristol, Bristol, UK; dHelwan University, Helwan, Egypt; eRoyal College of Paediatrics and Child Health, London, UK; fInstitute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK

Background: Type 2 Diabetes (T2DM) is increasing in childhood especially among females and South-Asians.

Objective: To report outcomes from a national cohort of children and adolescents with T2DM 1-year post diagnosis.

Subjects and Methods: Clinician reported 1-year follow-up of a cohort of children (<17 years) with T2DM reported through British Paediatric Surveillance Unit (April 2015–April 2016). This followed the same methodology as the survey in 2005, allowing direct comparisons across the decade.

Results: One hundred (94%) of 106 baseline cases were available for review. Of these, five were lost to follow up and one had a revised diagnosis. Mean age at follow up was 15.3 years. Mean BMI SDS was 2.72 with a mean increase of 0.13 SDS over a year. 15% of patients attained a normal HbA1c losing an average of 4% (CI −9.63 to 1.64) body weight. HbA1c <48 mmol/mol (UK target) was achieved in 38.8%. HbA1c was predicted by clinician reported compliance and attendance concerns (B=18.5 P=<0.0001). In over 50%, clinicians reported issues with compliance and attendance. Mean clinic attendance was 75%. Metformin was the most frequently used treatment at baseline (77%) and follow-up (87%). Microalbuminuria prevalence at 1-year was 16.4% compared to 4.2% at baseline and was associated with a higher HbA1c compared to those without microalbuminuria (60 vs 49 mmol/mol, P=0.033). The median HbA1c was higher in 2015 compared to 2005 (53 vs 48 mmol/mol) and BMI SDS fell by 0.11 a year after diagnosis in 2005 compared to an overall rise of 0.13 in 2015. In 2005, GLP-1 agonists were not used in the cohort of T2DM, however in 2015 4% of patients were reportedly on these drugs.

Conclusions: Adherence to treatment appears key to better outcomes a year after T2DM diagnosis. A body weight reduction of around 5% for patients may lead to diabetes resolution. Retention and clinic attendance are concerning. The prevalence of microalbuminuria had increased four-fold in the year following diagnosis and was associated with higher HbA1c.

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