Endocrine Abstracts

JOINT102

Background: Diabetes is a major global health problem, Until recently, immune-mediated type 1 diabetes mellitus was the only type of diabetes considered prevalent among children, now type 2 diabetes accounts for about 15% to 45% of all newly diagnosed cases of diabetes in children and teenagers (1). This could be due to the pandemic of obesity in childhood (2).

Case Report: 29 years old male patient diabetic 10 years ago presented with uncontrolled diabetes HbA1c 8.4 % on multiple daily injections. BMI 32 kg/m² and had acanthosis nigricans on the neck. We introduce metformin 2gm/day and decrease dose of insulin. He came on the next week with decreased attacks of hypoglycemia. We ordered C peptide and it was found normal hence we gave dulaglutide 1.5 weekly with metformin and decreased insulin gradually based on blood glucose. Three months later we stopped insulin and patient BMI 26 kg/m²and HbA1c 5.8 % on metformin and dulaglutide.

Discussion: Type 2 diabetes mellitus had always been considered a disease of older adults, while type 1 diabetes mellitus, was considered a disease of children (3). That is why our patient was misdiagnosed and managed as a case of type 1 diabetes. There has been an increase in the incidence of T2DM in children and adolescents. This is due to a rise in prevalence of obesity in adolescents (4). Presence of obesity, acanthosis nigricans and normal C peptide level confirmed our diagnosis(5)

Conclusion: We should raise awareness among clinicians that type 2 can occur in young adult and children to avoid mismanagement of diabetes.

References: 1. American Diabetes Association (2000) Type 2 Diabetes in Children and Adolescents. Paediatrics, 105, 671-680. 2. Mayer-Davis EJ, Lawrence JM, Dabelea D, et al., SEARCH for Diabetes in Youth Study. Incidence trends of type 1 and type 2 diabetes among youths, 2002-2012. N Engl J Med2017;376:1419-29. 3. Wilmot, E. and Idris, I. (2014) Early Onset Type 2 Diabetes: Risk Factors, Clinical Impact and Management. Therapeutic Advances in Chronic Disease, 5, 234-244. 4. Reinehr T. (2013) Type 2 Diabetes Mellitus in Children and Adolescents. World Journal of Diabetes, 4, 270-281. 5. Springer SC, Silverstein J, Copeland K, Moore KR, Prazar GE, Raymer T, Shiffman RN, Thaker VV, Anderson M, Spann SJ, et al. Management of type 2 diabetes mellitus in children and adolescents. Pediatrics. 2013;131:e648–e664.