Type 2 diabetes in prepubertal children

Abstract

Objective Puberty‐induced insulin resistance is considered critical in the pathogenesis of type 2 diabetes (T2D) in youth. The development of T2D before puberty suggests distinct risk factors and pathophysiology but, because of its rarity, this has not been well studied. We aimed to describe the clinical characteristics of children with T2D diagnosed before the onset of puberty. Research design and methods We retrospectively studied all children with autoantibody‐negative T2D and available pubertal development assessment seen at our center between July 2016 and July 2019, and compared characteristics of those at Tanner stage I (prepubertal, n = 35) versus those at Tanner II–V of pubertal development (n = 341). Results At T2D diagnosis, prepubertal children compared with those at Tanner II–V had higher body mass index z‐score (p = 0.003) and higher C‐peptide (p = 0.003) (while glucose levels were not significantly different), with differences retaining significance after adjustment for glucose, race/ethnicity and sex. Dyslipidemia occurred in 100% of prepubertal children versus 89.7% of those diagnosed later (p = 0.036). Of the prepubertal children diagnosed under age 10 (n = 13), 69.2% were female, 100% racial/ethnic minority, 100% had obesity with history of dyslipidemia and none with diabetic ketoacidosis. Conclusions T2D, although rarely, can develop before puberty. Children with T2D diagnosed in the prepubertal period have more severe obesity, greater insulin resistance, and more frequent dyslipidemia than older youth. These findings suggest that children with prepubertal T2D are at increased risk for associated morbidity compared with older youth and underscore the significance of interventions to prevent and treat obesity in early childhood.

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“…T2D was diagnosed at age 12 or older in 74.8% of the children with T2D, but 25.2% were younger. A recent study has reported children diagnosed with T2D younger than age 10, although it is very uncommon [ 9 ].…”

“…This is a secondary analysis of deidentified data from chart reviews of children newly diagnosed with T1D (n=758) between 2008 and 2010 [ 8 ] or T2D (n=753) between 2016 and 2019 [ 9 ] at a large academic hospital in Houston, Texas. Diabetes type was clinically assigned by their pediatric endocrinologist.…”

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“…The rapid β‐beta cell failure and the high morbidity seen in adolescent T2D underlines the need for prevention, early diagnosis, and aggressive treatment. The younger the child with T2D, the worse is the cardio‐metabolic profile 92 . Therefore, prevention and early identification of obesity, and simple fasting and post‐prandial BGL screening every 1–3 years, is especially important in LRS.…”

“…The younger the child with T2D, the worse is the cardio-metabolic profile. 92 Therefore, prevention and early identification of obesity, and simple fasting and post-prandial BGL screening every 1-3 years, is especially important in LRS. Delay in diagnosis may result in presentation in DKA, which needs initial insulin treatment.…”