Type 2 diabetes in a 5-year-old and single center experience of type 2 diabetes in youth under 10.
The worrisome rise in pediatric type 2 diabetes (T2DM) is most prevalent among minority ethnic/racial populations. Typically, T2DM occurs during puberty in high risk obese adolescents with evidence of insulin resistance. Screening for T2DM in obese youth can be a daunting task for pediatricians and differentiating between pediatric T1DM and T2DM in obese youth can be challenging for pediatric endocrinologists. There is very limited data regarding the prevalence of T2DM among youth < 10 years of age. Here we present the case of a 5-year-old Hispanic male diagnosed with T2DM after referral by his pediatrician for abnormal weight gain, acanthosis nigricans and an elevated HbgA1c. He subsequently became symptomatic for diabetes with confirmed hyperglycemia and HbgA1c of 9.7% (83 mmol/mol) at the time of formal diagnosis. Type 1 diabetes autoantibodies (GAD65, Islet, and ZincT8) and monogenic diabetes genetic tests were negative. Due to elevated liver enzymes and baseline HbgA1c, he received basal insulin as his initial therapy. In this paper, we will discuss this case and present an IRB approved retrospective review of the characteristics of the 20 T2DM patients <10 years of age identified to date in our pediatric diabetes center. This review highlights that while uncommon, the diagnosis of T2DM merits consideration even in prepubertal children. This is especially true when working with a high risk population, such as our Hispanic South Texas youth.
Department of Pediatrics, Division of Endocrinology & Diabetes & Genetics, The University of Texas Health Science Center at San Antonio, San Antonio, Texas.
Jessica
J
Hutchins
Department of Pediatrics, Division of Endocrinology & Diabetes & Genetics, The University of Texas Health Science Center at San Antonio, San Antonio, Texas.
Rose Ann
RA
Barajas
Department of Pediatrics, Division of Endocrinology & Diabetes & Genetics, The University of Texas Health Science Center at San Antonio, San Antonio, Texas.
Daniel
D
Hale
Department of Pediatrics, Division of Endocrinology & Diabetes & Genetics, The University of Texas Health Science Center at San Antonio, San Antonio, Texas.
Elia
E
Escaname
Department of Pediatrics, Division of Endocrinology & Diabetes & Genetics, The University of Texas Health Science Center at San Antonio, San Antonio, Texas.
Jane
J
Lynch
D000052:Acanthosis Nigricans / Q000150:complications; D017668:Age of Onset; D015992:Body Mass Index; D002675:Child, Preschool; D003131:Combined Modality Therapy; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications / Q000453:epidemiology / Q000628:therapy*; D004038:Diet, Reducing; D005192:Family Health; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D000070497:Healthy Lifestyle; D006630:Hispanic or Latino; D006801:Humans; D006943:Hyperglycemia / Q000517:prevention & control; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D000069036:Insulin Glargine / Q000627:therapeutic use*; D008297:Male; D009767:Obesity, Morbid / Q000150:complications* / Q000628:therapy; D063766:Pediatric Obesity / Q000150:complications* / Q000628:therapy; D012306:Risk; D013781:Texas / Q000453:epidemiology; D016896:Treatment Outcome
D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D000069036:Insulin Glargine; C517652:hemoglobin A1c protein, human
early onset type 2 diabetes; pediatric diabetes; type 2 diabetes mellitus