Department of Pediatric Endocrinology, Regency Center for Diabetes Endocrinology & Research, Regency City Clinic, Opposite PPN Market, Kanpur, 208001, India.
Indian J Pediatr. 2024 Dec;91(12):1244-1249. doi: 10.1007/s12098-024-05157-3. Epub 2024 Jun 3.
To identify determinants of the course of Type 2 diabetes in Indian adolescents.
Records of 37 adolescents (24 boys; 29 post pubertal and eight pubertal) with Type 2 diabetes (initial HbA1C 10.1 ± 1.9% and BMI SDS 2.0 ± 0.8; family history of diabetes in 33, 89.2%) diagnosed at 15.2 ± 2.5 y and followed up for 3.8 ± 2.2 y till 19.1 ± 3.3 y of age, were reviewed.
Initial treatment included insulin in 11 (29.7%), metformin alone in 22 (59.5%), and a combination of anti-diabetic medication in four (10.8%). Eleven subjects (29.7%) achieved remission at a median period of 5.3 mo (IQR- 17.13) after diagnosis; six of these relapsed within 0.9 ± 0.3 (range 0.4-1.3) y. The proportion of subjects requiring multiple anti-diabetic agents increased over follow-up (19% at six months, 32.5% at one year, 50% at two years, 59.1% at three, and 64.8% at four years), with the need for combination therapy after 0.9 ± 1.4 y. At the last follow-up, five were off treatment (13.5%), 10 (27%) were on metformin alone, and 22 (59.5%) were on multiple medications. The need for combination therapy at the last follow-up was lower in subjects with remission (27% against 73.1%, p = 0.02).
The findings of this study suggest delayed presentation and rapid progression of Type 2 diabetes in Indian adolescents. Diagnosis on screening and achievement of remission were predictors of good outcome.
确定印度青少年 2 型糖尿病病程的决定因素。
回顾了 37 名青少年（24 名男孩；29 名已过青春期，8 名处于青春期）的记录，他们患有 2 型糖尿病（初始 HbA1C 为 10.1±1.9%，BMI SDS 为 2.0±0.8；33 名有糖尿病家族史，占 89.2%），于 15.2±2.5 岁确诊，随访至 19.1±3.3 岁，随访时间为 3.8±2.2 年。
初始治疗包括 11 名（29.7%）患者使用胰岛素，22 名（59.5%）患者单独使用二甲双胍，4 名（10.8%）患者联合使用抗糖尿病药物。11 名患者（29.7%）在诊断后中位时间 5.3 个月（IQR-17.13）达到缓解；其中 6 名在 0.9±0.3（范围 0.4-1.3）年内复发。随着随访时间的延长，需要多种抗糖尿病药物的患者比例增加（6 个月时为 19%，1 年时为 32.5%，2 年时为 50%，3 年时为 59.1%，4 年时为 64.8%），0.9±1.4 年后需要联合治疗。在最后一次随访时，5 名患者已停药（13.5%），10 名患者（27%）仅使用二甲双胍，22 名患者（59.5%）使用多种药物。在最后一次随访时，缓解患者需要联合治疗的比例较低（27%对 73.1%，p=0.02）。
本研究结果表明，印度青少年 2 型糖尿病的发病较晚，进展较快。筛查诊断和缓解的实现是良好结局的预测因素。
