ESPE Abstracts

Background/Purpose: Case report of two siblings (nine-year-old boy and four-year-old girl) with rarely described factitious diabetes by proxy, aim ing to enhance physician’s awareness.

Methods: Initially the boy was referred by a physician to the outpatient clinic to apply (successfully) for an insulin pump. The mother convincingly claim ed her son has had T1DM for 3 years. Reported history started during hospitalization for asthma at another hospital, where hyperglycemia (230 mg/dL) following corticosteroid use was evaluated. Following admission, mother reported diagnosis of T1DM and follow-up in private. At first visit, the boy was on the Diabetes Registry, while the mother reported 12 IU TDD requirement. Furthermore, mother asserted diagnosis of T1DM for her daughter at the age of 3 and unilateral nephrectomy for hypoplastic kidney at three months of life. During the first follow-up visit following advanced hybrid closed-loop system placement, the boy consistently achieved 100% time-in-range, while insulin administration appeared minimal without meal boluses. This alerted the Team; removal of the insulin pump was requested, and an urgent admission of both children under the General Pediatrics Team was arranged.

Results: Both children were hospitalized, and a thorough physical and laboratory investigation ruled out T1DM. All relevant tests, including HbA1c, fasting and post-prandial C-peptide, extended OGTT with insulin measurements, auto-antibodies for diabetes and associated diseases were normal. The boy's medical history was requested from the Hospital that initially treated hyperglycemia, and this revealed that, despite the mother’s claims, T1DM and MODY had already been ruled out. Regarding the girl that was found to also be on the Diabetes Registry, also reportedly requiring insulin, again all tests described above were negative. Thorough search by the Child Safety Care Unit, revealed that both children were registered for T1DM social benefits, while the family had also claim ed social benefits for the nephrectomy. After concluding work-up Child Protection Services were alerted, and the investigation is currently ongoing. Of note the parents appeared relieved following their children’s “cure” and promised that they would comply with all requested tests and inquiries, while they also confided that despite having been prescribed insulin, it hadn’t been administered.

Conclusion: Physicians must be highly suspicious and trained to identify Munchausen syndrome by proxy that can be considered an intricate form of child abuse to prevent potentially damaging interventions. In this case, the parents successfully convinced Heath Care Services and although there was considerable risk in their children, only financial benefits were obtained.