ESPE Abstracts

Introduction: The term hybrid diabetes (HD) describes a form of diabetes in which hyperglycemia occurs in obese children in the presence of positive autoimmunity against the beta cells. Few data are available about the clinical presentation and the course of disease in children with this form of diabetes.

Aim: We describe the clinical characteristics and response to treatment in 7 children with hybrid diabetes.

Results: Seven children with HD diabetic patients whose mean age 10.8+/-0.98 years) were diagnosed and followed in our institution. At presentation, all patients were obese, with a mean BMI SD was = 2.73 +/-0.58, and 71 percent had acanthosis nigricans. Six out of seven patients had a family history of at least one type of diabetes (type 1, type 2, or gestational diabetes). The was checked and it was found that 2 patients had 2 autoantibodies against beta cells, 4 patients had 3 positive autoantibodies, and one patient had all 4 autoantibodies positive. The mean HbA1c at diagnosis was 10.6 % +/-2.1%. Four patients presented with the classical symptoms of polyuria, polydipsia, and recent weight loss along with hyperglycemia. Three patients presented with moderate to severe DKA. All patients were started on insulin at diagnosis, and 5 patients received metformin in the first week after diagnosis. During their follow-up, 4 patients did not require any insulin therapy and the other 3 patients had a marked reduction in the insulin requirement up to less than 0.2 unit/kg/day (2. 36 +/-2.79 months) after diagnosis. This was associated with a marked reduction of their HbA1c to 6.3%+/-0.7%. In addition, the mean BMI SD has dropped to 2.39 +/- 0.5 in the first 2 months after diagnosis, with a delta change = -0.34. The duration of either no insulin requirement or marked reduction in the total daily dose to less than 0.2 unit/kg/day continued for an average of 15 months. After this period 5 patients required initiating insulin or an increase in the insulin dose/kg. One child remained insulin-independent and one required a markedly low dose of 0.06 unit/kg/day to control glycemia.

Conclusion: The etiology behind hybrid diabetes is not well understood. We described the clinical characteristics of hybrid diabetes in 7 children and their response to treatment. All children with HD were obese at presentation and had easier control of their glycemia (long honeymoon period) and many did not require insulin during this period.