Prepubertal Childhood Onset Type 2 Diabetes Mellitus: Four Case Reports

The prevalence of childhood onset type 2 diabetes (T2D) is increasing, but prepubertal T2D is still unusual.

We report four cases of T2D with onset at or below 10 years of age registered at a tertiary diabetes centre in southern India.T2D was diagnosed based on the absence of ketosis, good beta cell reserve as shown by the C peptide assay, absence of GAD antibodies and pancreatic calculi, and response to oral hypoglycemic agents.

All four patients were female, obese and had acanthosis nigricans. Polycystic ovarian syndrome and fatty liver were found in two cases. All were treated with metformin but two patients needed insulin additionally. Two had hypercholesterolemia and hypertension. One patient developed non-proliferative diabetic retinopathy on follow up.

T2D is now beginning to be seen in the first decade of life. A proper clinical work up of children with diabetes will prevent misclassification as type 1 diabetes and help avoid unnecessary insulin therapy.