Connard James, Simonian Armine, Monzavi Roshanak, Samakar Kamran, Vidmar Alaina P
Children's Hospital Los Angeles and Keck School of Medicine of USC, Department of Pediatrics, Center for Endocrinology, Diabetes and Metabolism, Los Angeles, CA 90027, USA.
Children's Hospital Los Angeles and Keck School of Medicine of USC, Department of Surgery, Division of Pediatric Surgery, Los Angeles, CA 90027, USA.
JCEM Case Rep. 2025 Jul 17;3(9):luaf142. doi: 10.1210/jcemcr/luaf142. eCollection 2025 Sep.
The rising prevalence of youth-onset type 2 diabetes (T2D) in children necessitates early intervention with tight glycemic control, obesity medications, and metabolic and bariatric surgery (MBS). Insulin and metformin are standard treatments, but additional therapies for obesity in youth are needed. A 4-year-old Hispanic female with early-onset obesity and newly diagnosed T2D presented with a hemoglobin A1c (HbA1c) level of 8.0% (reference: < 5.7%), a fasting glucose of 147 mg/dL (SI units: 8.17 mmol/L) (reference: 70-115 mg/dL [3.33-6.39 mmol/L]), and a body mass index (BMI) of 41 kg/m². She had rapid weight gain and hyperphagia. Initially, insulin therapy was started, and her HbA1c decreased to 6.7% over 6 months. Insulin was discontinued and metformin 1000 mg twice daily was started. Topiramate 75 mg nightly was prescribed for obesity with minimal effect and so semaglutide was started and titrated to 2 mg weekly. By 27 months, her HbA1c improved to 5.1%, and overall, she had a 12% reduction in her percent above the 95th percentile (%BMI; BMI 41 kg/m²→35 kg/m²; %BMI = 205%→190%). This case underscores the importance of a multi-modal approach to managing pediatric T2D and obesity and highlights the effectiveness of semaglutide in improving both obesity and glycemic control.
儿童青少年2型糖尿病（T2D）患病率不断上升，因此需要通过严格的血糖控制、使用肥胖症药物以及代谢和减重手术（MBS）进行早期干预。胰岛素和二甲双胍是标准治疗方法，但青少年肥胖还需要其他治疗方法。一名4岁西班牙裔女性，患有早发性肥胖症且新诊断为T2D，糖化血红蛋白（HbA1c）水平为8.0%（参考值：<5.7%），空腹血糖为147 mg/dL（国际单位：8.17 mmol/L）（参考值：70 - 115 mg/dL [3.33 - 6.39 mmol/L]），体重指数（BMI）为41 kg/m²。她体重迅速增加且食欲亢进。最初开始胰岛素治疗，6个月内她的HbA1c降至6.7%。停用胰岛素，开始每日两次服用1000 mg二甲双胍。每晚服用75 mg托吡酯治疗肥胖症，但效果甚微，因此开始使用司美格鲁肽并滴定至每周2 mg。到27个月时，她的HbA1c改善至5.1%，总体而言，她高于第95百分位数的百分比（%BMI；BMI从41 kg/m²降至35 kg/m²；%BMI从205%降至190%）降低了12%。该病例强调了采用多模式方法管理儿童T2D和肥胖症的重要性，并突出了司美格鲁肽在改善肥胖症和血糖控制方面的有效性。
