ESPE Abstracts

Introduction: Secondary diabetes (drug-induced and related to diseases of pancreas) increases the burden of care of patients, associated with less favorable outcomes. For many medications, most evidence comes from case reports or extrapolations of adult data and this condition is poorly documented as priority is given to the primary disease. Here we aimed to describe the patients diagnosed as secondary diabetes in our clinic and present the long-term follow-up data.

Methods: All patients diagnosed with secondary diabetes between 2012-2024, followed in our pediatric endocrinology and diabetes department were included. Patient records were retrieved through a retrospective, electronic and manual file scan.

Results: A total of 18 patients (10 males) were diagnosed as secondary diabetes. Median age at diagnosis was 13.4 (5.2-18.3) years. While 3/18 patients were born small for gestational age, four were large for gestational age. Eight had a family history of diabetes. Of the patients, 8/18 had a diagnosis of hematologic malignancy (w or w/o bone marrow transplantation), one had been operated for pancreas tumor, 4/18 had underwent pancreatectomy for hyperinsulinemic hypoglycemia, 3/18 had a renal transplant, one diagnosed with cystic fibrosis and one with ulcerative colitis. Multiple agents had been prescribed (inc. corticosteroids, cyclophosphamide, methotrexate, tacrolimus, sirolimus, everolimus, mycophenolate mofetil, growth hormone…) All patients were diagnosed with hyperglycemia (no ketoacidosis); 16/18 during routine control, the remaining two with diabetic symptoms prompting them to seek for medical advice. At diagnosis, only 1/18 had a body mass index SDS >2. Median hemoglobin A1c level at diagnosis was 7 (5.8-15.5) %. All subjects had normal thyroid function tests while 2/18 had elevated thyroid antibody levels and one had a diagnosis of coeliac disease. Anti glutamic acid decarboxylase antibodies were positive in two patients. Median fasting c-peptide level was 1.95 mcg/L and prandial 4.6 mcg/L. Hyperlipidemia was present in 8/18. Insulin was started in 16/18 (one switched to metformin). The other two had an OGTT at diagnosis and diabetes regressed only with diet and exercise in short term. Median follow-up duration was 2.2 years (0.3-10.3). Median A1c at last follow-up was 6.2 (5.2-10) %. Diabetes was permanent in 6/18 and recurred in 2/18. Nephropathy and retinopathy occurred in 2/18.

Conclusion: Although guidelines omit subtypes of this condition, identification of pediatric patients with increased risk of secondary diabetes, and treatment in a timely manner is critical. Long-term follow-up is warranted even in cases with remission due to the probability of recurrence.