Endocrine Abstracts

Introduction

Prediabetes and type 2 diabetes prevalence in children and teenagers has been rising lately, according to obesity increase in this population. Diabetes is the first cause of kidney failure in this individuals. These clinical entities are associated with hypertension and dyslipidemia, leading to an increased risk for cardiovascular disease. In this case, as a result of the presence of a diabetic complication, the differential diagnosis of the cause of diabetes is reconsidered.

Case report

33-year-old-woman diagnosed with hypertension, obesity and type 1 diabetes developed at the age of 14. She currently has no glycemic control (last HbA1c determination 2 years ago: 12%) and her diet is based on refined carbohydrates and processed food products. She is supposed to follow a treatment regimen consisting of insulin Glargine once a day and insulin Aspart at meals, but she acknowledges treatment nonadherence. She is admitted to the hospital because of fever, swelling and purulent drainage of second and fourth fingers of her left foot, being finally hospitalized for intensive intravenous antibiotic therapy and surgical drebidement. During the hospital admission she has normal glucose levels without insulin treatment, just following a balanced diet. Due to this unexpected well-controlled glucose levels, her diabetes diagnosis is reconsidered. Her disease history was checked: she was diagnosed with tuberculous meningitis at the age of 4 so she was under treatment with high-dose corticosteroids for several months. It led to iatrogenic Cushing syndrome, reduced growth and eventually short height. She received treatment with growth hormone during childhood and developed diabetes during puberty. She started treatment with oral antidiabetic drugs but due to uncontrolled glycemias she is finally treated with insulin regimen. In order to clarify her type of diabetes, some tests are done: glucose 175 mg/dl, HbA1c 8.7%, serum insulin level 7.1 (3–25 mUI/ml), C-peptide 2.63 (0.81–3.85 ng/ml), ACTH 16.1 (5–50 pg/ml), serum cortisol 9.8 (5–25 mg/dl), PCR-us 2.31. Anti-insulin, anti-tyrosine phosphatase y anti-glutamate antibodies were negative. Considering this results, she is finally diagnosed with type 2 diabetes. During the hospitalization she receives diabetes self-management education and at hospital discharge she is recommended to follow a treatment with Metformin twice a day and Losartan daily.

Conclusions

It is important to reconsider established diagnosis when a disease does not follow the expected progression and clinical manifestations. Nowadays, type 2 diabetes is a common disease in children and teenagers and its proper diagnosis is essential for an adequate treatment.