Management and 1 year outcome for UK children with type 2 diabetes

Abstract

Objective: To report the 1-year outcome for children newly diagnosed as having type 2 diabetes in the UK.

Design: Follow-up study of a UK national cohort.

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

Results: Follow-up data were available for 73 of the 76 cases. The mean age at follow-up was 14.5 years, 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 body mass index (BMI) SDS at diagnosis was 2.89, and mean change at 1 year was -0.11 (range -1.53 to +1.37). At 1 year, only 58% achieved the American Diabetes Association/European Association for the Study of Diabetes recommended treatment target (glycated haemoglobin < or =7.0%). There was no relation between improvement in BMI and improvement in glycated haemoglobin. There was wide variation in choice of treatments and regimens. Hypertension is a common comorbidity (34%), whereas early nephropathy appears to be rare (4%). Evidence of polycystic ovarian disease was common in girls (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 affect 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 of long-term microvascular and macrovascular complications.