Toddler May Be Youngest Person Ever Diagnosed With Type 2 Diabetes
Early diagnosis and treatment needed to reverse type 2 diabetes in very young patients.
A 3-year-old Hispanic girl from Texas may be the youngest person ever to be diagnosed with type 2 diabetes, Michael Yafi, MD, reported at EASD 2015, the annual meeting of the European Association for the Study of Diabetes.
The child presented to the Texas pediatric endocrinology clinic where Yafi, who is a pediatric endocrinologist at the University of Texas in Houston, is based for evaluation of obesity.
Symptoms of excessive urination and thirst were present, although 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.
The toddler had no cushingoid features, no thyrogmegaly, and her Tanner Stage was I.
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 obesity and weight gain. On laboratory tests, she had high fasting plasma glucose and HbA1c. However, she tested negative for type 1 diabetes.
The girl was started on a liquid version of metformin 500 mg daily, and her parents received diabetes and nutritional education. The medical team asked the family to implement lifestyle modifications by controlling food portions and total calorie intake and increasing the child's physical activity.
The toddler lost weight, which led to normalization of blood glucose levels. 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. She also had normal blood glucose levels, an HbA1c of 5.3% and was no longer taking metformin.
The diabetes epidemic is expanding in children much in the same way as it is expanding in adults. Currently, more and more children are affected by both obesity and type 2 diabetes. Yafi presented this case study to highlight the critical importance of early identification of pediatric patients at risk for the disease.
Prompt diagnosis and early therapy can reverse the disease, according to Yafi.
He said clinicians should be aware of the possibility of type 2 diabetes, even in very young obese children and that this is very much a growing concern.
“This case showed the importance of screening for type 2 diabetes at any age in obese patients,” Yafi told Endocrinology Advisor.
“The most important take-home message for endocrinologists is that early detection of type 2 diabetes mellitus is essential at any age.
Yafi presented this case study at the meeting to highlight the critical importance of early identification of pediatric patients at risk. He said prompt diagnosis and early therapy can reverse the disease.
- Yafi M et al. Abstract 303: A toddler with type 2 diabetes. Presented at: EASD 2015; Sept. 14-18, 2015; Stockholm.