ESPE Abstracts

Introduction: Disease-modifying agents, such as anti-CD3 monoclonal antibodies, have shown promising outcomes in improving the management of Type 1 Diabetes (T1D). Immunotherapy with teplizumab has delayed the onset of T1D for three years. It is been administered intravenously for 14 days in children and young people (CYP) aged > eight years already in stage 2 (multiple islet autoantibodies, abnormal glucose tolerance, usually pre-symptomatic). This treatment has not yet been approved in Europe. Other studies of immune intervention in the early stages of T1D are already underway. In cases of early diagnosis of T1D, insulin treatment is recommended as an initial therapeutic intervention.

Objective: To present a case of T1D management in stage 2 in a 8.5-year-old pre-pubertal girl.

Material-Methods: The patient was referred to the Pediatric Diabetes Clinic due to borderline fasting blood glucose (BG) levels, 100 mg/dl (5.6 mmol/L), HbA1c 6.3% (45mmol/mol) and positive pancreatic autoantibodies. Past medical history was unremarkable. Maternal grandmother's brother has late onset Diabetes (LADA). Physical examination was normal, height 147cm (>97th), weight 37 kg (75-90th), BMI 16.67 kg/m² (50th). An insulin glucose curve was performed (table 1). Continuous glucose monitoring with stricter glycemic target limits (Time in Tight Range (TITR) 70-140 mg/dl (3.8-7.7mmol/l) and an adapted diet plan was used.

Results: OGTT showed impaired glucose tolerance, postprandial BG values were 8-10% above the target range. She was started on insulin treatment with basal insulin Degludec at a low dose (0.1 IU/Kg/d) with satisfactory results, HbA1c 5.8 -6% (40-42 mmol/mol), TITR 90-92%. Pancreatic autoantibodies were positive, anti-GAD 200IU/mL, anti-ICA (75.3 U/mL), as the HLA class II DR/DQ histocompatibility antigens which express the HLA DQ2 positive genotype (indicative in 40-60% of people with T1D).

Conclusion: Early diagnosis of T1D and timely initiation of insulin treatment contribute to the preservation of β-cells. Thus, acute complications such as diabetic ketoacidosis (DKA) are avoided, contributing to the achievement of normoglycemia over time. However, it is accompanied by increased parental anxiety and needs appropriate management. Early detection of T1D will significantly contribute to the treatment and progression of the disease minimizing future complications, increasing the life expectancy and improving the quality of life of the patients.