Al-Musa Hassan M
Department of Family and Community Medicine, College of Medicine, King Khalid University, Saudi Arabia.
J Family Med Prim Care. 2019 Jan;8(1):313-315. doi: 10.4103/jfmpc.jfmpc_426_18.
To report a Saudi young patient with early onset type 2 diabetes, who was misdiagnosed for 6 years as type 1 diabetic.
A Saudi male aged 18-year old presented with uncontrolled diabetes. He was diagnosed 6 years earlier to have type 1 diabetes mellitus. He was kept insulin, but he was not compliant to treatment and his blood glucose kept on fluctuating and not controlled. He came to our diabetes center for management of his uncontrolled diabetes. There was no past history of hospitalization. His father was type 2 diabetic. His body mass index was 46.7 kg/m. His glycosylated hemoglobin (HbA1c) level was 9.9%. Immune dysfunction was evaluated using serum antibody levels of glutamic acid decarboxylase, which proved to be negative (0.7 U/mL), while serum C-peptide level was not low (2.2 ng/mL). Therefore, the patient was diagnosed as early onset type 2 diabetic, not type 1 diabetic. The patient was advised to start physical exercise through daily walking for at least 1 h. The dietitian planned a strict diet plan for him to follow. Insulin injections and Metformin tablets were started. The patient received detailed health education on nature and management of his condition. After 4 months, his body mass index became 39.4 kg/m and his HbA1c became 6%. Insulin was stopped, and he was advised to continue on metformin, the diet, and daily walking. Two months later, his body mass index was 37.7 kg/m and his HbA1c became 5.41%.
Early onset type 2 diabetes should be suspected among obese children with symptoms of diabetes. Proper health education and patient's compliance to medication, diet, and physical activity are essential for successful management of early onset type 2 diabetes. Moreover, primary care physicians need to be aware that type 2 diabetes is not necessarily adult-onset.
报告一名沙特年轻的早发型2型糖尿病患者，该患者被误诊为1型糖尿病长达6年。
一名18岁的沙特男性因糖尿病控制不佳前来就诊。他在6年前被诊断为1型糖尿病。一直使用胰岛素治疗，但他不遵医嘱，血糖持续波动且未得到控制。他来到我们的糖尿病中心寻求对其控制不佳的糖尿病进行管理。既往无住院史。他的父亲患有2型糖尿病。他的体重指数为46.7kg/m。糖化血红蛋白（HbA1c）水平为9.9%。通过检测谷氨酸脱羧酶血清抗体水平评估免疫功能，结果为阴性（0.7U/mL），而血清C肽水平不低（2.2ng/mL）。因此，该患者被诊断为早发型2型糖尿病，而非1型糖尿病。建议患者通过每天至少步行1小时开始体育锻炼。营养师为他制定了严格的饮食计划以供遵循。开始注射胰岛素和服用二甲双胍片。患者接受了关于其病情性质和管理的详细健康教育。4个月后，他的体重指数变为39.4kg/m，HbA1c变为6%。停用胰岛素，建议他继续服用二甲双胍、遵循饮食计划并坚持每日步行。两个月后，他的体重指数为37.7kg/m，HbA1c变为5.41%。
对于有糖尿病症状的肥胖儿童，应怀疑早发型2型糖尿病。适当的健康教育以及患者对药物治疗、饮食和体育活动的依从性对于早发型2型糖尿病的成功管理至关重要。此外，初级保健医生需要意识到2型糖尿病不一定是成人发病。
