Background: The most striking change in diabetes over recent years has been the convergence of previously distinctive phenotypes. Recently diagnosed children are younger, taller and with greater BM. Pediatric endocrinologists are facing with children presenting mixed signs of both diabetes types. So called hybrid diabetes, or type 1½ has insulin resistance in type 1 phenotype and vice versa autoimmunity in obese children.
Patients and methods: Ten children (6 girls and 4 boys), with recently diagnosed diabetes and on insulin treatment, aged mean 12.45 years (range 5.516) with mean BMI of 22 kg/m2 and GHbA1c of 9.66% at admission, two weeks later additionally received Metformin as insulin senzitizer and apoptosis reducing agent. Including criteria were basal C peptide over 0.2 pmol/l and preserved pulsatility of insulin secretion.
Results: Treated children entered faster in remission period and according to daily glycemic profiles insulin was gradually excluded. Mean insulin free period was 1.6 years (range 0.23.5) with mean GHbA1C of 6.37%. Only 3 of them needed small insulin doses 2, 4 and 12 IU of intermediate acting insulin, according to age and BM.
Conclusion: Diabetes in childhood is changing its well known face. In this hybrid diabetes insulin sensitizer combined with insulin in early period could have favorable effect on metabolic control and duration of remission period.
25 - 29 Apr 2009
European Society of Endocrinology