Endocrine Abstracts

Introduction: Type 1 diabetes (T1DM) occurs as a result of autoimmune destruction of pancreatic β-cells which is supported by the presence of autoantibodies well before the onset of T1DM. Individuals at risk for T1DM are characterised by a deficient first-phase insulin response and impaired glucose tolerance which is present before the onset of T1DM.

Case: We describe a case of 6 year-old asymptomatic girl who took part in the TrialNet Pathway-to-Prevention (PTP) study in which relatives of people with T1D were screened to assess their risk of developing T1D. She was found to be positive for all 5 autoantibodies thus increasing her risk of developing T1D. Moreover her HbA1c was 40 mmol/mol at presentation consistent with pre-diabetes state. Although she was clinically asymptomatic her blood glucose (BG) was intermittently above 11 mmol/l. Thus it was agreed to commence her on FreeStyle Libre for monitoring of her BG which demonstrated post-meal glucose excursion only after teatime with BG above 12 mmol/l. Therefore although asymptomatic she was commenced on Novorapid using ICR 1:50 to manage her evening meal. Within 6 months she was found to have post-meal BG excursion at breakfast and was started on Novorapid. Currently 18 months after the introduction of sc insulin for only breakfast and teatime her glycaemic control is excellent as is demonstrated from the Libre download and HbA1c of 36 mmol/mol.

Conclusion: We present 6 year-old asymptomatic girl who was found to have 5 positive autoantibodies which were identified as part of the TrailNet research and had her BG levels monitored by FreeStyle Libre flash glucose monitoring system which detected post-meal BG excursion at breakfast and tea and were managed on small amount of sc Novorapid. She has remained asymptomatic 18 months since started on insulin with excellent glycaemic control. This case raises interesting question about how best to manage asymptomatic children with high risk of developing T1D. Further studies are required to determine which factors contribute to prevention and delayed progression of pre-diabetes to type 1 diabetes in paediatric population.