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STOCKHOLM -- Clinicians here reported that a 3 1/2-year-old morbidly obese girl was diagnosed with an adult disease -- type 2 diabetes, but with treatment and lifestyle changes the child was able to be weaned off medication.
"This is probably the youngest reported case of pediatric type 2 diabetes," said Michael Yafi, MD, director of pediatric endocrinology at the University of Texas Health Science Center. "You see type 2 diabetes in obese kids but usually not until they are about age 9 and are near puberty. This girl was very young and was morbidly obese."
In his poster presentation at the annual meeting of the European Association for the Study of Diabetes, Yafi said that because the child essentially reversed her disease and normalized blood sugar levels may mean that older individuals whose diabetes is detected early may also have their disease course altered if they can also change their lifestyle.
"This girl responded very well to treatment," he told MedPage Today. "Her mom was very aware of the pathophysiology of type 2 diabetes so she implemented measures such as better food choices, portion control, and physical activity which had the effect of reversing diabetes. We started her on metformin in a liquid form and this helped her improve her insulin resistance."
But poster discussion session moderator, Tiinamaija Tuomi, MD, PhD, director of diabetology at Helsinki University Hospital, challenged the diagnosis of type 2 diabetes, saying, "There was no genetic testing that was done on this child so the diabetes might not have been type 2 but rather a genetically-caused form of diabetes. I think to be certain these genetic tests should have been performed."
Yafi said that in the environment where he works in southern Texas, type 2 diabetes is endemic, and the child responded to treatments aimed at correcting type 2 disease. He also contended that genetic testing was an added expense that may not have been needed in this case or in his population without other factors being apparent.
And Yafi was enthusiastic about the success with this one case, he said he expects that he will begin seeing more very young children with type 2 diabetes.
"The most important factors in type 2 diabetes are obesity and lifestyle. We think this girl responded well because her condition was detected early and was treated early. When you implement major lifestyle changes then you have a higher rate of success," he said.
The Hispanic child presented at the pediatric endocrinology clinic with symptoms of excessive urination and thirst -- clinical descriptors of people with diabetes. "However her past medical history was unremarkable," Yafi said. "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 -- 230 mg/dl -- and HbA1c of 7.2%; however she tested negative for antibodies that would reveal type 1 diabetes.
Yafi said: "Based on symptoms, physical findings of obesity and laboratory results the diagnosis of type 2 diabetes was made."
The girl was started on liquid metformin (500 mg daily) because she was too young to swallow the pills. 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 normalization 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. The girl is now 5 years old and continues to do well, Yafi said, although she is still considered to be a type 2 diabetes patient.
"Reversal of type 2 diabetes in children is possible by early screening of obese children, early diagnosis, appropriate therapy, and life style modification of the child and family," he said.
"The incidence of T2DM has increased dramatically worldwide in children due to the epidemic of child obesity," Yafi said. "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."
Yafi and Tuomi disclosed no relevant relationships with industry.
- Reviewed by Henry A. Solomon, MD, FACP, FACC Clinical Associate Professor, Weill Cornell Medical College and Dorothy Caputo, MA, BSN, RN, Nurse Planner
European Association for the Study of DiabetesSource Reference: Yafi M et al, "A toddler with type 2 diabetes" EASD 2015; Abstract 303.