Endocrine Abstracts

Background: Type 2 diabetes mellitus (T2DM) is increasingly prevalent in children and young people due to increasing rates of obesity. The benefits of a dedicated T2DM clinic include MDT input and standardisation of patient care. The aim of this study was to evaluate current practice for management of T2DM upon initiation of the first dedicated T2DM paediatric clinic in Scotland.

Methods: Retrospective review of clinical information via electronic patient records (Clinical Portal and the Scottish Care Information Diabetes Collaboration (SCI-DC) platform) of all CYP aged under 18 years diagnosed with T2DM between 2018 and 2023 at the Royal Hospital for Children, Glasgow.

Results: Of 814 patients under review at the paediatric diabetes service, 26 (3%) had T2DM (n = 18), impaired glucose tolerance (n = 7) or diabetes not defined (n = 1). Fourteen (54%) were female, 13 (50%) were Caucasian and 13 (50%) were from ethnic minority backgrounds. The median age at diagnosis was 13.7 years (range 9.6, 15.7) and duration of diagnosis was 2.7 years (0.2, 5.0). Thirteen (50%) were from very deprived areas (Scottish index of multiple deprivation (SIMD) deciles 1 to 3). All had a BMI of >25 at diagnosis; 14 (54%) had a BMI of >35. Ethnic minority groups had a lower BMI at presentation. There was no difference in BMI SDS at presentation and at 12 months [3.2 (2.3, 4.7) vs 3.1 (2.2, 4.5), P = 0.58]. HbA1c was lower at 12 months post presentation [51 (37,124) vs 45 (30, 105) mmol/mol], P = 0.02. A family history of T2DM was noted in 21 (81%); in 13 (50%), either one or both parents had T2DM. At presentation, 10 (38%) had metabolic complication. Over 60% of patients had psychiatric comorbidity (n = 12) or learning difficulties (n = 4). Pharmacologic treatment was commenced in 15 (58%) and included metformin monotherapy (n = 6), insulin monotherapy (n = 3), metformin and insulin (n = 5) and liraglutide (n = 1); 14 (54%) were still on pharmacologic treatment at 12 months post diagnosis.

Conclusion: A notable fall in HbA1c 12 months post diagnosis was observed, however, there was no change in BMI. An MDT approach with dietetic involvement from presentation is vital to reduce risk of metabolic comorbidity.