Characteristics of Turkish children with Type 2 diabetes at onset: a multicentre, cross‐sectional study

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 wa...

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Published in:	Diabetic medicine Vol. 36; no. 10; pp. 1243 - 1250
Main Authors:	Hatun, S., Yesiltepe Mutlu, G., Cinaz, P., Turan, S., Ekberzade, A., Bereket, A., Erbas, M. Y., Akcay, T., Onal, H., Bolu, S., Arslanoglu, I., Doger, E., Yilmaz, A. A., Ucakturk, A., Karabulut, G. S., Tuhan, H. Ü., Demir, K., Erdeve, S. S., Aycan, Z., Nalbantoğlu, Ö., Kara, C., Gungor, N.
Format:	Journal Article
Language:	English
Published:	England Wiley Subscription Services, Inc 01-10-2019
Subjects:	Adolescents Children Cross-sectional studies Diabetes Diabetes mellitus Diabetes mellitus (non-insulin dependent) Diagnosis Endocrinology Insulin Laboratories Metformin Pediatrics
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Summary:	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. What's new? Female gender and positive family history were strongly associated with Type 2 diabetes in Turkish children as well as children in western countries. More than half (57%) of the participants were identified by opportunistic diabetes screening due to existing risk markers, without typical symptoms of diabetes. Approximately half of the children (47%) with Type 2 diabetes were treated with insulin while only 13% were treated solely by lifestyle modification.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0742-3071 1464-5491
DOI:	10.1111/dme.14038