Type 2 diabetes in prepubertal children

Authors: ASTUDILLO, MARCELA - Baylor College Of Medicine; TOSUR, MUSTAFA - Texas Children'S Hospital; CASTILLO, BEATRIZ - Baylor College Of Medicine; REFAEY, AHMED - Texas Children'S Hospital; SILLER, ALEJANDRO - Texas Children'S Hospital; NIETO, JACOBO - Rice University; SISLEY, STEPHANIE - Children'S Nutrition Research Center (CNRC); MCKAY, SIRIPOOM - Texas Children'S Hospital; NELLA, AIKATERINI - Texas Children'S Hospital; BALASUBRAMANYAM, ASHOK - Texas Children'S Hospital; BACHA, FIDA - Children'S Nutrition Research Center (CNRC); REDONDO, MARIA - Texas Children'S Hospital

Submitted to: Pediatric Diabetes
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 8/7/2021
Publication Date: 10/18/2021
Citation: Astudillo, M., Tosur, M., Castillo, B., Refaey, A., Siller, A., Nieto, J., Sisley, S., McKay, S., Nella, A.A., Balasubramanyam, A., Bacha, F., Redondo, M.J. 2021. Type 2 diabetes in prepubertal children. Pediatric Diabetes. 22(7):946-950. https://doi.org/10.1111/pedi.13254.
DOI: https://doi.org/10.1111/pedi.13254

Interpretive Summary: Puberty is associated with increased insulin resistance which is a risk factor for type 2 diabetes (T2D) in youth. The development of T2D before puberty is rare. We aimed to describe the clinical characteristics of children with T2D diagnosed before the onset of puberty. Researchers studied all children with T2D between July 2016 and July 2019, and compared characteristics of those who had not started puberty (prepubertal) to those who were in puberty at diagnosis of diabetes. At T2D diagnosis, prepubertal children had higher body mass index and higher insulin production, and were more likely to have elevated lipids (100% versus 89.7%). Of the prepubertal children diagnosed under age 10 (n = 13), two thirds were female, 100% racial/ethnic minority, 100% had obesity with history of elevated lipids. They conclude that 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. Interventions to prevent and treat obesity need to start in early childhood.

Technical Abstract: Background: Only a few cases of T2D have been reported in children younger than 10 years of age. Given the aggressiveness of youth-onset T2D and the accelerated development of comorbidities and complications, recognition of this unique subgroup and its characteristics is imperative. We aimed to determine the prevalence and characteristics of children with T2D diagnosed <10 years old (y/o) at a large academic pediatric hospital in the Southwestern U.S. We conducted a retrospective review of electronic medical records of 1,138 children and adolescents up to 21 years of age who were given a diagnosis of T2D in our clinic. We compared the demographic and biochemical characteristics at the time of diabetes diagnosis between children diagnosed <10 y/o vs. =10 y/o, and by puberty status within the <10 y/o group. In our overall T2D population, 67.3% were females, 9.9% non-Hispanic White (NHW), 59% Hispanic (Hisp), 26.8% African-American (AA). The mean age at diagnosis was 13.8± 2.6 (±SD) y/o (range 3.0-21.7). The children diagnosed with T2D <10 y/o constituted 5.6%, n=64 of our total T2D population; mean age 8.8± 1.0 y/o (range 4.1-9.9). 52.2% were pre-pubertal (Tanner Stage [TS]-I). 81.2% had islet autoantibodies test available (including GAD, ICA-512 and IAA) and all had negative results. Children with T2D diagnosed <10 y/o were more likely to be female (79.7%) than youth diagnosed =10 y/o (61.4%, p=0.003). We observed no racial/ethnic distribution differences between the two groups (p=0.58). Within the group diagnosed <10 y/o, children who were prepubertal, compared with those at =TS-II, were more likely to be male (33.3% vs. 0%, p=0.035), had a higher BMI-Z score (2.71 vs. 2.47, p=0.036), and tended to have a different racial/ethnic distribution (83.3% Hisp and 16.7% AA vs. 45.5% and 54.6%, respectively, p=0.057). In conclusion, less than 10% of youth with T2D are diagnosed under age 10 years; those in this group who are pre-pubertal (>50%) are distinctly atypical and have other unique characteristics that warrant further study.