Author(s): Awa WL, Boehm BO, Rosinger S, Achenbach P, Ziegler AG,
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Abstract AIM: To characterize the clinical and immunological features of HLA-typed youth with pediatric onset of type 2 diabetes mellitus (T2DM). METHOD: One hundred and seven patients with clinically diagnosed T2DM (aged ≤20 yr at diagnosis) were examined. DNA and serum, obtained after a median diabetes duration of 2.2 (Q1-Q3: 0.8-4.6) yr, were used for centralized HLA-typing and autoantibody (GADA, IA-2A, ZnT8A) measurements. RESULTS: 64.6\% of patients were female and median age at diagnosis was 13.8 (Q1-Q3: 11.6-15.4) yr. Patients were obese [median body mass index-standard deviation score (BMI-SDS): 2.6 (2.0-3.1)], 88.0\% had a family history of diabetes and 40.2\% a migration background. Islet autoantibodies were detected in 16 (15.0\%), among which 7 (6.5\%) had multiple islet autoantibodies. Autoantibody positive patients had poorer metabolic control than autoantibody negative patients [glycosylated hemoglobin A1c (HbA1c): 8.1 (6.9-10.1) \% vs. 6.6 (5.9-8.0) \%; p = 0.033], while patients with HLA-DR genetic risk had higher BMI-SDS than those with HLA-DRXX [2.6 (2.4-3.7) vs. 2.4 (1.7-2.9); p = 0.007]. Metabolic syndrome (61.7\%), microalbuminuria (13.4\%), and retinopathy (3.9\%) were diagnosed. Therapies used were lifestyle only (35.5\%), oral anti-diabetics (OAD) only (43.3 \%), insulin + OAD (15.9\%) and insulin only (5.6\%). Patients with β-cell autoimmunity or HLA-DR genetic risk more frequently used insulin than confirmed T2DM patients (50.0 vs. 22.0\%; p = 0.037) and less often had diabetic relatives (61.1 vs. 86.0\%; p = 0.030). CONCLUSION: T2DM was confirmed in about 90\% of patients while about 10\% with β-cell autoimmunity or HLA-DR genetic risk likely had either T1.5DM or 'double diabetes' or an unknown diabetes type. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
This article was published in Pediatr Diabetes
and referenced in Journal of Diabetes & Metabolism