A toddler with type 2 diabetes

The diabetes epidemic is expanding in children as it expands in adults, with more and more children affected by both obesity and type 2 diabetes. Early identification of paediatric patients at risk, prompt diagnosis and early therapy are major factors to help reverse the disease.

A three-and-a-half year-old Hispanic female presented to the paediatric endocrinology clinic where Dr Yafi is based for evaluation of obesity. She had symptoms of excessive urination and thirst, however her past medical history was unremarkable. She was born full term with a weight of 3.2 kg. Although both parents were obese, there was no history of diabetes.

A review of the child's diet revealed poor family nutritional habits with uncontrolled counting of calories and fat. On physical examination, the child's weight was 35 kg (in the top 5% of all children her age), and her height and BMI were also in the top 5% of all children her age. She underwent tests to rule out other potential causes of her obesity and weight gain, and laboratory tests revealed her to have high fasting plasma glucose and HbA1c; however she tested negative for antibodies that would reveal type 1 diabetes.

Dr Yafi says: "Based on symptoms, physical findings of obesity and laboratory results the diagnosis of type 2 diabetes was made."

The girl was started on a liquid version of the diabetes drug metformin (500 mg daily). Diabetes and nutritional education were given to her parents, and the medical team asked the family to implement lifestyle modification by controlling their food portions and total calorie intake, and increasing the child's physical activity. The girl then lost weight that lead to normalisation of blood glucose levels. The metformin therapy was decreased by 50% each month, and then stopped. Six months after diagnosis, the girl was at 75% of the weight she had been when she presented for treatment, had normal blood glucose levels, an HbA1c of 5.3% and had stopped metformin therapy.

Dr Yafi concludes: "Reversal of type 2 diabetes in children is possible by early screening of obese children, early diagnosis, appropriate therapy and lifestyle modification."

He adds: "The incidence of T2DM has increased dramatically worldwide in children due to the epidemic of child obesity. Clinicians should be aware of the possibility of type 2 diabetes even in very young obese children, although of course type 1 diabetes can also still occur in obese children and is in fact much more common in young children than type 2 diabetes."