Endocrine Abstracts

Background: Adolescent type 2 diabetes mellitus (T2DM) is a complex condition with increasing prevalence and rapidly changing management strategies. We characterise patients and treatment approaches in our multidisciplinary paediatric T2DM clinic.

Method: Data was collected retrospectively using electronic patients records for all current patients with T2DM.

Results: Ten patients with T2DM were identified; 80% female, mean age at diagnosis 13.0 years (±1.9SD) years. Six were White British, two South Asian and two Black African. Mean follow-up was 2.8 years (±2.0SD). Five patients were diagnosed through screening for HbA1C in the complications of excess weight clinic. Two presented with osmotic symptoms and were initially managed as type 1 diabetes mellitus. Two were diagnosed through investigations for other conditions, with one patient having vaginal candidiasis and another autoimmune encephalitis. One patient had a severe perineal infection at diagnosis, presenting in sepsis with diabetic ketoacidosis. 40% had a diagnostic oral glucose tolerance test; average fasting blood glucose 4.7 mmol/l (±0.5SD) and 9.9 mmol/l (±3.1SD) at 120 minutes. C-Peptide was measured in 80%; mean value 1875pmol/l (±1553.2SD). 80% had diabetes autoantibodies measured: negative in all patients except one with concurrent GAD autoimmune encephalitis managed with high dose steroids. Mean HbA1c at diagnosis was 80.4 mmol/mol (±36.8SD) and 57.3 mmol/mol (±21.4SD) during follow-up. All patients were obese at diagnosis: mean BMI 31.4 kg/m²(±4.6SD) (BMI SDS +2.91(±0.54SD)), and 31.2 kg/m² (±5.1SD) (BMI SDS +2.46 (±1.07SD)) during follow-up. 70% had a strong family history of T2DM. Patients had access to a specialist dietitian, clinical psychologist and paediatric diabetes nurse specialist at medical appointments. 50% were receiving monotherapy (80% metformin; 20% sodium-glucose cotransporter 2 (SGLT-2) inhibitor) and 50% a combination of medications (one metformin/SGLT-2 inhibitor; two metformin/insulin and two metformin/SGLT-2 inhibitor/glucagon-like peptide 1 (GLP-1) agonist). 40% had hepatic steatosis; one hypertension, one bilateral proliferative retinopathy from diagnosis and nephropathy and one is being investigated for obstructive sleep apnoea.

Conclusions: Our cohort is predominantly female and White British, with half detected through screening. Metformin is still widely prescribed but newer therapies are being adopted. With early-onset of complications in adolescence, further clinical trials are urgently needed to identify optimal management strategies.