Endocrine Abstracts

Aim: Review of the demographics, clinical presentation, management and monitoring of complications in children and young people with type 2 diabetes.

Methods: A retrospective review of medical records was conducted for patients with type 2 diabetes under the care of the Paediatric Diabetes Service at Oxford University Hospitals.

Results: At the time of review, 13 patients (76% female, mean age of 16.2±2 years) were under care of the service. The mean age at diagnosis was 13.7±2.45 years. 38% patients were Asian, followed by White British (30%). A family history of type 2 diabetes was present in both parents for 5 patients and in one parent for 4 patients; for the rest of patients it was unknown. At diagnosis, 30% of patients presented with classical symptoms (polyuria and polydipsia), while 40% presented with nonspecific symptoms such as fatigue or were diagnosed during screening for excess weight by elevated HbA1c. All patients tested negative for diabetes-related antibodies. The mean HbA1c at diagnosis was 81±39 mmol/mol (median 66). Initial treatment included metformin in 70% of patients. Basal insulin was required from diagnosis in 38%, and 3 patients commenced on basal-bolus therapy with metformin added once antibody results were available. At the most recent review, 76% of patients remained on metformin; half of these were also prescribed empagliflozin. Two patients were treated with a GLP-1 receptor agonist. Complications included hypertension (38%), hypercholesterolemia (30%), metabolic dysfunction-associated steatotic liver disease in 46%, and polycystic ovary syndrome in 30% of female patients. Two patients had a diagnosis of autism spectrum disorder, 2 anxiety, and 1 was on child protection plan. Review of patient records revealed that not all individuals had full screening for excess weight and diabetes-related complications in first year post diagnosis. At 6 months post-diagnosis (data available for 11 patients), the mean HbA1c was 55 ± 21 mmol/mol. The most recent HbA1c (10 patients) was 66 ± 10 mmol/mol.

Summary: The most recent median HbA1c remained above the therapeutic target. To improve care pathways we have updated the local guideline and developed proforma for the first appointment and annual reviews.