Management and one year outcome for UK children with type 2 diabetes

Julian Paul Hamilton Shield ^1*, Richard Lynn ², Kay C Wan ², Linda Haines ² and Timothy Geoffrey Barrett ³

¹ University of Bristol, United Kingdom
² Research Division, Royal College of Paediatrics and Child Health, United Kingdom
³ University of Birmingham, United Kingdom

^* To whom correspondence should be addressed. E-mail: j.p.h.shield{at}bristol.ac.uk.

Accepted 24 September 2008

Abstract

Objective: To report the one year outcome for newly diagnosed children with type 2 diabetes in the United Kingdom (UK).

Design: Follow up study of a UK national cohort.

Subjects: All children under the age of 17 years diagnosed with type 2 diabetes from 1 October 2004 to 31 October 2005 (inclusive).

Results: Follow up data was available for 73 of the 76 cases. The mean age at follow-up was 14.5 yrs, with mean duration of diabetes 1 year. The revised incidence of type 2 diabetes in the UK in children under 17 years is 0.6/100,000/year. The mean BMI SDS at diagnosis was 2.89 and mean change at one year was -0.11 (range: -1.53 to +1.37). At one year only 58% achieved the ADA/EASD recommended treatment target (HbA1c 7.0%). There was no relation between improvement in BMI and improvement in HbA1c. There was wide variation in choice of therapies and regimes. Hypertension is a common co-morbidity (34%) whilst early nephropathy appears rare (4%). Evidence of polycystic ovarian disease was common in females (26%). 22% of children had not been screened for nephropathy or retinopathy during the first year after diagnosis.

Conclusions: The 3.8% mean reduction in BMI SDS in the first year after diagnosis indicates that many children find it hard to make the necessary lifestyle changes needed to positively impact upon metabolic health . Physicians are using a wide variety of treatment regimens which are relatively effective in achieving glycaemic targets but systematic screening for complications is incomplete. There is an urgent need to develop an evidence base for effective treatment and management protocols to reduce the risks for long term micro- and macro-vascular complications.