Introduction: The prevalence of paediatric Type 2 diabetes (T2DM) is increasing, contributed by rising incidence of obesity worldwide. Paediatric T2DM is a progressive disease with increased risk of complications and morbidities. Despite recent research, many aspects such as its pathophysiology and optimal management remain unknown.
Aim: To characterise the cohort of T2DM patients across 2 large tertiary paediatric diabetes centres and evaluate current management practices.
Method: Retrospective data was collected from medical notes of all paediatric T2DM patients in Bristol and Cardiff.
Results: Out of 20 T2DM patients, 60% were female. Mean age at diagnosis was 13.3 (± 1.9) years and mean duration of diagnosis was 2.98 (± 2.3) years. 75% were Caucasian. Positive family history in a first-degree relative was reported in 85%. Commonest clinical feature at diagnosis were obesity (65%). Median fasting glucose and C-peptide level at diagnosis were 8 mmol/l and 1870 pmol/l respectively. Pancreatic antibodies were measured in 90% of whom 10% had GAD antibodies. Current mean HbA1C (60.3±19.1 mmol/mmol) was not significantly different from that at diagnosis(65.6±17.5 mmol/mmol). Improvement of latest mean BMI SDS (1.89±0.6) from that at presentation (2.14±0.4) was 0.25. 80% had at least one comorbidity (dyslipidaemia, hypertension, microalbuminuria, fatty liver, PCOS, OSA), commonest being dyslipidaemia and hepatic steatosis (55%). All patients had lifestyle counselling including dietetic appointments (median=3.5 per year) and weight management advice. 25% were on low-calorie diet (<1400 Kcal/day). 45% children were on monotherapy (metformin in 30%, insulin in 5% and GLP-1 analogue in 5%). Double therapy included: metformin/GLP-1 analogue in 25%, metformin/insulin in 10% and metformin/SGLT-2 inhibitor in 10%. 15% were on a combination of 3 drug therapies.
Conclusions: Interestingly, the majority of our cohort is Caucasian, whereas other studies report a preponderance of non-Caucasian ethnicity in T2DM. Similar to other studies, obesity and positive family history are the most important risk factors. BMI SDS improvement was 0.25, an encouraging finding as it is known that an improvement of >0.25 can improve insulin sensitivity. Similar to that in literature, 10% of cohort had positive GAD antibodies. Dyslipidaemia and hepatic steatosis were the commonest co-morbidities. There is a clear shift from insulin therapy to newer therapies (GLP1 agonists and SGLT-2 inhibitors). Medical and dietetic management varied considerably similar to other studies, highlighting need for clinical trials, especially with the newer medications and low calorie diet to identify optimal treatment strategies.
15 Sep 2022 - 17 Sep 2022