ESPE Abstracts

Background: There has been in recent years a significant increase of incidence of obesity and Type 2 diabetes (T2D) in children and young people (CYP). Most therapeutics research for T2D has been done in adults. There is increasing concern of high risk patients that are very slow to respond to our standard approach, especially as youth with T2D have greater degree of insulin resistance, more rapid beta cell failure and prevalence of complications compared with adult onset T2D.

Case Report: We describe a 15 year old male who was diagnosed with T2D age 13, on a background of severe obesity and learning difficulties. Previous genetics of obesity testing was negative. Despite intensive support and escalating treatment, his control has deteriorated and weight continued to increase. During hospital admission, with a total daily dose of 360 units insulin/day, he was started on Empagliflozin, a Sodium Glucose cotransporter 1 (SGLT1) inhibitor. There was a stunning response with Time In range improving from 0 to 68% but the results were unfortunately transient. Patient was referred to Complications of Excessive Weight (CEW) clinic, support from social care was put in place, but the family engagement was poor. Family are struggling due to mental health, socio-economic burdens and strained family relationships. Latest parameters at age 15 years 6 months are Weight 205.9 kg, Height 183.4 cm, BMI 61.21 kg/m2. Our patient also has non-alcoholic fatty liver disease (NALFD), Obstructive Sleep Apnoea (OSA), mobility issues and psychology distress due to bullying. We have escalated to multi professional meetings, safeguarding and social with increased concerns regarding his safety.

Conclusion: This case illustrates how difficult can be to engage a family with complex psycho-social dynamics, and raises the question of what are the alternative therapies for young people with early onset T2D? At what age can we start considering referring young people to bariatric surgery and is this likely to help? We know it requires strong compliance with diet postoperatively and the family to be fully on board. While new therapies are being considered, the consistent support of family remains the crucial element for any therapy to succeed.