Endocrine Abstracts

Background: Type 2 diabetes mellitus (T2DM) is becoming increasingly prevalent in children and young people (CYP), mainly linked to the rise in obesity. It is associated with higher and earlier risk of developing complications; therefore, prompt diagnosis and management involving the multidisciplinary team (MDT) is crucial. The aim of our study was to evaluate the current practice for T2DM management and monitoring of complications at our centre.

Methods: We performed a retrospective audit at the paediatric diabetes unit of Oxford Children’s Hospital, UK. All CYP (less than 18 years) diagnosed with T2DM between 2016 and 2022 were included. We collected data related to diagnostic approach, management and follow up of this population.

Results: 21 CYP aged between 9 and 18 years were managed for T2DM. There was equal distribution between both sexes (11 males, 10 females); however, most were from ethnic minority backgrounds (67% vs 33% Caucasian). Most children had a BMI over 25 at diagnosis and 12 months (86% and 70% respectively), and a third had a BMI > 35 (29% and 25% respectively). 90% of our population had an HbA1c>53 mmol/mol at diagnosis, dropping to 35% at 12 months. Initial pharmacologic therapy consisted mainly of Metformin alone (43%), but basal bolus insulin (14%), Metformin and long-acting basal insulin (29%), fixed rate intravenous insulin infusion (9%) and Gliclazide (5%) were used. Metabolic complications noted at diagnosis included: hypertension (19%), hypercholesterolaemia (29%), hypertriglyceridaemia (38%) and deranged liver function (38%). According to 2-year post-diagnosis clinic review, only 10% had BMI <25 and 9% came off pharmacologic treatment. Although 44% managed to lower HbA1C below 48 mmol/mol, 19% HbA1C remained dangerously high (>70 mmol/mol). We also noted significant association with syndromic obesity (24%) and learning difficulties (19%) in our cohort.

Conclusion: We observed that whilst intensive pharmacologic therapy was associated with a fall in HbA1c at 12 months, we did not see a noticeable drop in BMI which leaves this population vulnerable for further metabolic complications. Hence, we propose MDT approach including intensive dietetic involvement from diagnosis and if needed, escalation of pharmacological treatment within first 6 months to achieve better glycaemic control.