Endocrine Abstracts

Childhood onset Type 2 diabetes mellitus is appearing in Asia. Sadly, the risk factors appear to be obesity, a sedentary lifestyle, and a family history of type 2 diabetes mellitus or gestational diabetes and IUGR. Comorbidities include abnormal lipid profiles, steatohepatitis, hypertension for age and obstructive sleep apnoea

Modalities of treatment include diet, exercise, insulin, metformin, and sulphonylureas and more recently, the use of insulin sensitizers is being investigated. How should our approach be toward the child who is obese, has acanthosis nigricans, but who has a normal OGTT ? Diet and exercise are often advised, but we are dealing with a subset of children who resist weight loss, and who often gain weight despite our best efforts. Since 1992, a nationwide school based exercise and dietary restriction programme in Singapore has limited obesity to 12% of the school population, but is of limited use in severely overweight children. Cultural and social attitudes, along with academic pressures and parental ignorance get in the way. A prevalent attitude is that if you do not have to take medicine, you are not really ill. Recent evidence in adults suggests that metformin can delay progression of impaired glucose tolerance to diabetes. Metformin is cheap, safe, proven, and easily available. Side effects are rare and well tolerated. In Singapore we will use metformin in DM, IGT and Impaired Fasting Glucose patients as well as those with severe obesity ( eg Wt for Ht >150% of normal). Children with normal glucose tolerance may have severe insulin resistance as measured by HOMA, or by insulin area under OGTT curves. Metformin results in decreased HbA1c, decreased fasting glucose, and decreased fasting insulin. Metformin has also proved a useful addition to children with type 1 diabetes, but who require large doses of insulin due to insulin resistance.