S Hatun1, G Yesiltepe Mutlu1, P Cinaz2, S Turan3, A Ekberzade3, A Bereket3, M Y Erbas4, T Akcay4,5, H Onal4, S Bolu6, I Arslanoglu6, E Doger2, A A Yilmaz7,8, A Ucakturk8, G S Karabulut9, H Ü Tuhan10, K Demir10, S S Erdeve7, Z Aycan7, Ö Nalbantoğlu11, C Kara12, N Gungor13. 1. Koç University School of Medicine, Division of Pediatric Endocrinology and Diabetes, Turkey. 2. Gazi University, School of Medicine, Division of Pediatric Endocrinology and Diabetes, Turkey. 3. Marmara University, School of Medicine, Division of Pediatric Endocrinology and Diabetes, Turkey. 4. Kanuni Sultan Suleyman Training and Research Hospital, Turkey. 5. Istinye University, Medical Park Gaziosmanpasa Hospital, Pediatric Endocrinology Unit, Turkey. 6. Düzce University, Faculty of Medicine, Division of Pediatric Endocrinology and Diabetes, Turkey. 7. University of Health Sciences, Dr. Sami Ulus Obstetrics and Gynecology, Children's Health and Disease Training and Research Hospital, Clinic of Pediatric Endocrinology, Turkey. 8. University of Health Sciences, Ankara Child Health and Diseases Hematology Oncology Training and Research Hospital, Department of Pediatric Endocrinology, Turkey. 9. Kocaeli University, Faculty of Medicine, Division of Pediatric Endocrinology and Diabetes, Turkey. 10. Dokuz Eylül Faculty of Medicine, Division of Pediatric Endocrinology and Diabetes, Turkey. 11. University of Health Sciences, Dr. Behçet Uz Children Diseases and Surgery Training and Research Hospital, Department of Pediatric Endocrinology, Turkey. 12. Ondokuz Mayıs University, Faculty of Medicine, Department of Pediatric Endocrinology and Diabetes, Turkey. 13. Department of Pediatrics, Division of Endocrinology, Louisiana State University Health Sciences Center, Shreveport, LA, USA.
Abstract
AIMS: To describe the baseline clinical and laboratory findings and treatment modalities of 367 children and adolescents diagnosed with Type 2 diabetes in various paediatric endocrinology centres in Turkey. METHODS: A standard questionnaire regarding clinical and laboratory characteristics at onset was uploaded to an online national database system. Data for 367 children (aged 6-18 years) newly diagnosed with Type 2 diabetes at 37 different paediatric endocrinology centres were analysed. RESULTS: After exclusion of the children with a BMI Z-score < 1 SD, those with genetic syndromes associated with Type 2 diabetes, and those whose C-peptide and/or insulin levels were not available, 227 cases were included in the study. Mean age was 13.8 ± 2.2 (range 6.5-17.8) years, with female preponderance (68%). Family history of Type 2 diabetes was positive in 86% of the children. The mean BMI was 31.3 ± 6.5 kg/m2 (range 18.7-61) and BMI Z-score was 2.4 ± 0.8 (range 1-5). More than half (57%) of the children were identified by an opportunistic diabetes screening due to existing risk markers without typical symptoms of diabetes. Only 13% (n = 29) were treated solely by lifestyle modification, while 40.5% (n = 92) were treated with metformin, 13% (n = 30) were treated with insulin, and 33.5% (n = 76) were treated with a combination of insulin and metformin initially. Mean HbA1C levels of the insulin and combination of insulin and metformin groups were 98 (11.1%) and 102 mmol/mol (11.5%), respectively, and also were significantly higher than the lifestyle modification only and metformin groups mean HbA1C levels (70(8.6%) and 67 mmol/mol (8.3%), respectively). CONCLUSIONS: An opportunistic screening of children who are at high risk of Type 2 diabetes is essential, as our data showed that > 50% of the children were asymptomatic at diagnosis. The other important result of our study was the high rate of exclusion from the initial registration (38%), suggesting that accurate diagnosis of Type 2 diabetes in youth is still problematic, even for paediatric endocrinologists.
AIMS: To describe the baseline clinical and laboratory findings and treatment modalities of 367 children and adolescents diagnosed with Type 2 diabetes in various paediatric endocrinology centres in Turkey. METHODS: A standard questionnaire regarding clinical and laboratory characteristics at onset was uploaded to an online national database system. Data for 367 children (aged 6-18 years) newly diagnosed with Type 2 diabetes at 37 different paediatric endocrinology centres were analysed. RESULTS: After exclusion of the children with a BMI Z-score < 1 SD, those with genetic syndromes associated with Type 2 diabetes, and those whose C-peptide and/or insulin levels were not available, 227 cases were included in the study. Mean age was 13.8 ± 2.2 (range 6.5-17.8) years, with female preponderance (68%). Family history of Type 2 diabetes was positive in 86% of the children. The mean BMI was 31.3 ± 6.5 kg/m2 (range 18.7-61) and BMI Z-score was 2.4 ± 0.8 (range 1-5). More than half (57%) of the children were identified by an opportunistic diabetes screening due to existing risk markers without typical symptoms of diabetes. Only 13% (n = 29) were treated solely by lifestyle modification, while 40.5% (n = 92) were treated with metformin, 13% (n = 30) were treated with insulin, and 33.5% (n = 76) were treated with a combination of insulin and metformin initially. Mean HbA1C levels of the insulin and combination of insulin and metformin groups were 98 (11.1%) and 102 mmol/mol (11.5%), respectively, and also were significantly higher than the lifestyle modification only and metformin groups mean HbA1C levels (70(8.6%) and 67 mmol/mol (8.3%), respectively). CONCLUSIONS: An opportunistic screening of children who are at high risk of Type 2 diabetes is essential, as our data showed that > 50% of the children were asymptomatic at diagnosis. The other important result of our study was the high rate of exclusion from the initial registration (38%), suggesting that accurate diagnosis of Type 2 diabetes in youth is still problematic, even for paediatric endocrinologists.