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Approach to Diagnosing a Pediatric Patient With Severe Insulin Resistance in Low- or Middle-income Countries

Alise A van Heerwaarde1, Renz C W Klomberg1, Conny M A van Ravenswaaij-Arts1,2

  • 1Department of Pediatrics, Academic Pediatric Center Suriname, Academic Hospital Paramaribo, Paramaribo, Suriname.

The Journal of Clinical Endocrinology and Metabolism
|July 28, 2021
PubMed

Insights

Diagnosing insulin-resistant diabetes mellitus in children is crucial for effective treatment. A detailed medical history and physical exam can identify severe insulin resistance, even in resource-limited settings.

Area of Science:

  • Pediatric Endocrinology
  • Metabolic Disorders

Background:

  • Diabetes mellitus (DM) in children often stems from impaired insulin secretion (Type 1 DM).
  • Increased insulin resistance presents a distinct challenge, with higher insulin needs (>2.0 U/kg/day) signifying severe cases.
  • Early diagnosis of severe insulin resistance is vital for targeted therapies and preventing complications.

Observation:

  • A case study of a Surinamese adolescent with severe insulin-resistant DM revealed autosomal recessive congenital generalized lipodystrophy (Berardinelli-Seip syndrome).
  • Many disorders causing severe insulin resistance in pediatric patients require advanced diagnostics, often unavailable in low- and middle-income countries.
  • Clinical presentation and physical examination are key to identifying insulin-resistant DM.

Findings:

  • A systematic approach, prioritizing medical history and physical examination, can accurately diagnose insulin-resistant DM in children.
  • This diagnostic strategy is particularly relevant for resource-limited healthcare settings.
  • The case highlights the importance of considering rare genetic disorders like Berardinelli-Seip syndrome.

Implications:

  • This approach facilitates early and accurate diagnosis of insulin-resistant DM in diverse healthcare settings.
  • It enables timely initiation of appropriate management strategies for pediatric patients with severe insulin resistance.
  • Improved diagnostic accessibility can lead to better outcomes and reduced long-term complications of pediatric diabetes.

Keywords:
Berardinelli–Seip syndromeDiabetes mellituschildreninsulin resistancelipodystrophylow- or middle-income country

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