Background: The incidence of Paediatric type 2 diabetes is increasing, especially in areas of deprivation.
Aim: To describe the cohort of CYP with T2D in Royal London Hospital over the period 20092018.
Methods: Retrospective analysis of patient cohort.
Results: Number of new patients doubled from 2.6/year in 20092013 to 5.3/year in 20142018. Prevalence in our cohort is 7.5% (national average of 2.5%, NPDA 20172018). Fourty patients (25 female, 15 male) were diagnosed in 20092018, with a mean age at diagnosis of 13.9+/−1.7yrs. Males had more frequently learning difficulties compared to females (40% vs 20%). Sixty % of patients were Asian compared to 28% in our T1D cohort. BMI at presentation was 31.5 kg/m2 (23 females) and 33.85 kg/m2 (13 males). BMI remained stable for females for the first year after diagnosis but in males increased to 34.6 kg/m2 (n=10). At diagnosis, Metformin was started in 38/40 patients although 7 patients reduced the dose and 6 stopped due to side effects. 12/36 patients started also on long-acting insulin (0.28+/−0.17 U/kg), in 6 combined with prandial insulin (0.42+/−0.20 U/kg). Seven patients started long-acting insulin at a later stage and 6 required prandial insulin too. 1 patient was treated with Sitagliptin. HbA1c at diagnosis (n=27) was 75.2+/−20 mmol/mol, similar for males and females. HbA1c dropped to 55.0+/−17.4 mmol/mol after 3 months, to increase again to 63.0+/−25.8 and 67+/−28 after one (n=25) and 2 years (n=23). Nineteen of 38 patients achieved a HbA1c < 48 at least once, but only 9 of 35 achieved an HbA1c < 48 for a year. Of these, 3 continued to be on insulin and in 1 patient insulin was stopped. Two patients relapsed. Complications were as follows: 11/21 hypertension, 6/28 sleep apnoea, 10/30 raised ALT and 9/24 fatty liver.
Conclusion: Learning difficulties in patients with T2D are frequent. Complications of obesity/T2D are common in this cohort. Current treatment does not achieve permanent reduction in BMI and HbA1c in most patients although temporary reduction of HbA1c is possible. New treatment approaches are needed to improve outcomes.
27 - 29 Nov 2019
British Society for Paediatric Endocrinology and Diabetes