Endocrine Abstracts

Objective: Incidence of paediatric type 2 diabetes appears to be increasing. We describe our cohort of paediatric type 2 diabetes at Barts Health NHS Trust in East London (UK) over the period 2008-2018 to gain insight in incidence, complications and outcomes.

Methods: Retrospective cohort study. Data collection from Twinkle (electronic database for diabetes) and paper notes.

Results: Fourty patients (25 female) were diagnosed with T2D at an age of 13.9±1.7 years. Sixty percent were Asian compared to 28% in our T1D cohort. New patients doubled from 2.6/year in 2009-2013 to 5.3/year in 2014-2018. Currently, T2D accounts for 12.5% of our paediatric diabetes cohort. Sixty eight percent had co-morbidities. Learning disabilities were common, more so in males than females (47% vs 16%). At diagnosis, mean BMI was 32.4±6.71 kg/m², BMI SDS 2.87±0.70. BMI was 31.7 kg/m² for females (n=23) and 33.8 kg/m² for males (n=13) (P=0.35). Patients diagnosed in 2014-2018 had higher mean BMI SDS, compared to 2008-2013 (3.06±0.56 vs 2.52±0.81, P=0.02) but a lower HbA1c at diagnosis (69.4±19.2 mmol/mol vs 89.0±19.2 mmol/mol, P=0.02). BMI and BMI SDS did not change during 2 years follow-up. Mean HbA1c at diagnosis was 75.2±21.0 mmol/mol, decreasing to 55.0±17.4 mmol/mol after 3 months (P=0.001) but increasing to 63.0±25.5 mmol/mol at 1 year (P=0.07). HbA1c <48 mmol/mol was achieved in 22/37 patients, but only 9/37 patients maintained this for a year, and 2 patients relapsed after this year. Diabetes complications included hypertension (n=9/21), dyslipidaemia (n=9/30), raised ALT (n=7/30), fatty liver (n=7/24) and sleep apnoea (n=6/26) with similar frequency at diagnosis and during follow-up. Metformin was started in 38/40 patients, 7 patients reduced the dose and 6 stopped due to side effects. 14/37 patients started also on long-acting insulin (0.30 ±0.16 U/kg), and in 6 combined with prandial insulin (0.42 ±0.20U/kg). Thirty patients had left paediatrics by 2022, 15 succesfuly transitioned to adult services, 7 were lost to follow up and discharged to their GP, and 4 were discharged to their GP due to diabetes reversal. Mean HbA1c one year after transition (n=9) was 70.3±28.2 mmol/mol compared to 74.7±27.6 mmol/mol at transition and 74.7±24.9 mmol/mol at diagnosis.

Conclusion: High burden of co-morbidities and complications is common amongst youth with T2D. Current management does not achieve permanent reduction in BMI or HbA1c, although temporary reduction in HbA1c is achieved in many patients. New treatment approaches are needed to improve outcomes, including strategies for follow-up after transition to adult services.