Abdelhameed Farah, Giuffrida Anna, Thorp Ben, Moorthy Myuri K, Gevers Evelien F
Barts Health NHS Trust-Royal London Children's Hospital, London E1 1BB, UK.
William Harvey Research Institute, Barts and The London Medical School, Queen Mary University of London, London EC1M 6BQ, UK.
Children (Basel). 2024 Jan 29;11(2):173. doi: 10.3390/children11020173.
The rising prevalence of paediatric type 2 diabetes (T2D) is concerning, particularly with limited medical intervention despite evidence of accelerated disease progression. This study of a Barts Health NHS Trust cohort from 2008 to 2022 aims to elucidate the incidence, clinical outcomes, and complications associated with paediatric T2D. A retrospective analysis utilising electronic and paper records identified 40 patients with T2D. The incidence doubled from 2.6/year in 2008-2013 to 5.4/year in 2014-2018. Sixty-eight percent exhibited co-morbidities, notably learning disabilities. At diagnosis, the mean BMI was 32.4 ± 6.71 kg/m, with no gender-based disparity and no significant change over a two-year follow-up. The initial HbA1c was 75.2 ± 21.0 mmol/mol, decreasing to 55.0 ± 17.4 mmol/mol after three months ( = 0.001) and then rising to 63.0 ± 25.5 mmol/mol at one year ( = 0.07). While 22/37 patients achieved HbA1c < 48 mmol/mol, only 9 maintained this for a year. Several metabolic and cardiovascular complications were observed at diagnosis and follow-up, with no significant change in frequency. In 2022, 15 patients transitioned to adult services. HbA1c at transition was 74.7 ± 27.6 mmol/mol, showing no change one year post-transition (71.9 ± 26.9 mmol/mol, = 0.34). This study highlights substantial therapeutic failure, with current management falling short in achieving a sustained reduction in BMI or HbA1c. Novel treatment approaches are needed to improve clinical outcomes and address the high burden of co-morbidities and complications.
儿童2型糖尿病（T2D）患病率的上升令人担忧，尤其是尽管有证据表明疾病进展加速，但医疗干预却有限。这项对2008年至2022年巴茨健康国民保健服务信托队列的研究旨在阐明与儿童T2D相关的发病率、临床结局和并发症。利用电子和纸质记录进行的回顾性分析确定了40例T2D患者。发病率从2008 - 2013年的每年2.6例增加了一倍，至2014 - 2018年的每年5.4例。68%的患者有合并症，尤其是学习障碍。诊断时，平均体重指数为32.4±6.71kg/m²，无性别差异，且在两年随访期间无显著变化。初始糖化血红蛋白（HbA1c）为75.2±21.0mmol/mol，三个月后降至55.0±17.4mmol/mol（P = 0.001），然后在一年时升至63.0±25.5mmol/mol（P = 0.07）。虽然37例患者中有22例糖化血红蛋白<48mmol/mol，但只有9例维持了一年。在诊断和随访时观察到一些代谢和心血管并发症，其发生率无显著变化。2022年，15例患者转诊至成人服务机构。转诊时的糖化血红蛋白为74.7±27.6mmol/mol，转诊一年后无变化（71.9±26.9mmol/mol，P = 0.34）。这项研究突出了大量的治疗失败情况，当前的管理在实现体重指数或糖化血红蛋白的持续降低方面存在不足。需要新的治疗方法来改善临床结局，并应对合并症和并发症的高负担。
