Endocrine Abstracts

Introduction: Research has shown that Type 2 diabetes can be reversed in early stages if diet control is exercised. We present herewith a case of a 13-year old girl with Type 2 diabetes with a background of brain tumour, epilepsy and learning difficulties. Due to wider psychosocial issues the patient was placed in foster care. Adherence to healthy lifestyle principles led to weight loss and subsequent resolution of the Diabetes.

Case report: A 5-year-old Asian girl presented with seizures and hemiparesis. She was diagnosed with hypothalamic chiasmatic low-grade glioma and was successfully treated with surgery and chemotherapy. The patient was regularly followed up at the late effect clinic. She was diagnosed with central precocious puberty at 7 years and treated with GnRH analogue. She was noted to be morbidly obese (BMI of 38.5 kg/m²) with acanthosis nigricans and irregular periods at 13 years. There was a family history of type 2 diabetes and hence she was closely monitored. She eventually developed type 2 diabetes with HbA1c levels of 53 mmol/mmol and an abnormal OGTT and was started on Metformin. Her fasting insulin levels were 107 miu/l with HOMA IR of 38. Meanwhile due to persistent social concerns, after much deliberation the child was removed from the family environment to foster care. Healthy diet along with regular exercise not only led to improvement in the weight profile but also enhanced her glycemic control. The HbA1c came down to 29 mmol/mmol and she was weaned off metformin. Her insulin levels came down to 23.7 miu/l with HOMA IR of 4.4. BMI dropped to 23 kg/m² and her periods became regular.

Conclusion: Though there is evidence to suggest that diet control and weight loss can lead to reversal of Type 2 diabetes, our case is unique with regards to her age, social profile and different management approach. It highlights the fact that a more holistic approach, which may seem extreme (as in this case) can yield desired results and hence should be considered.