Bedowra Zabeen MBBS, FCPS, FRSPH, Consultant Paediatric Endocrinologist, Director BADAS Paediatric Diabetes Care and Research Center Address: Room 309, 1/A Shegunbagicha, BIRDEM Women and Children Hospital Dhaka - 1000, Bangladesh; Cell +8801819259647, Email: bzabeen@gmail.com
Introduction: Although the diagnosis of T2 D is rare < 10 years of age but still it should be considered among high-risk population. Objective: The objective was to determine the clinical characteristics and glycemic control of children with T2DM diagnosed before 10 years of age.
Methods: Retrospective electronic medical record review of children diagnosed with T2DM before 10 years of age at BADAS Pediatric Diabetes care and Research Center in BIRDEM Hospital, Bangladesh over 12 years was conducted. Patient baseline characteristics with glycemic control were analyzed.
Results: Our cohort of 55 youth <10 years of age with T2DM were diagnosed between the ages 5 to 9.9 years with the median age 9.0[8.1- 9.4] years, 80.0% were female. All had Family history of DM and H/O GDM was present in 25(45.5%) patients. Forty-three (78.2%) patients had acanthosis nigricans. The non-alcoholic fatty liver disease was reported in 17 (30.9%) with mild to moderate fatty change, and 18 (32.7%) patients had dyslipidemia. More than 80.0% required insulin with metformin or insulin alone at the time of diagnosis. Median C peptide was 1.9[1.4 – 3.0] ng/ ml. Median fasting blood glucose was 14.3[7.6-17.1] mmol/ and HbA1C at diagnosis was 11.5[9.0-13.1]. Improvement was seen after 6 months with median HbA1c 7.7[7.0-9.3], 22.2% patients achieved optimal glycemic control (HbA1C ≤6.5%).
Conclusions: Early screening of children who are at high risk of Type 2 diabetes is essential, as our data showed a substantial number of children diagnosed with T2 DM < 10 years of age in Bangladesh. Key findings revealed that the age at diagnosis was not significantly different between rural and urban patients. Still, the age at registration was considerably higher in rural patients, suggesting delays in seeking care. A higher proportion of urban patients reported a family history of Type 2 diabetes. Diabetic ketoacidosis (DKA) was more common at diagnosis in urban patients, while rural patients had significantly higher fasting blood sugar levels, indicating poorer glycemic control. Although HbA1c levels were slightly higher in rural patients, this difference was not statistically significant. This study underscores the disparities in healthcare access and outcomes between rural and urban populations in Bangladesh. Rural patients face challenges related to delayed diagnosis, poor glycemic control, and lower socioeconomic status, which may exacerbate disease progression. The findings highlight the need for targeted interventions to improve healthcare access, diabetes awareness, and early detection, particularly in rural regions, to reduce the burden of T1DM in Bangladesh.
Keywords: Type 1 diabetes, rural-urban differences, Bangladesh, socioeconomic status, glycemic control, diabetic ketoacidosis, healthcare access.
Introduction
Type 1 diabetes has traditionally been the most prevalent form of diabetes among children. However, there is a notable rise in type 2 diabetes (T2DM) in this age group, reϐlecting a broader global health challenge [1]. This increase in youth-onset T2DM is intimately tied to the escalating epidemic of childhood obesity and increasingly sedentary lifestyles. Although the diagnosis of youth-onset T2D is extremely low among pre- pubertal children however, it has been reported in children younger than 10 years. In the pediatric population, the onset of type 2 diabetes is most often around the adolescence period, however, there are rare reports of type 2 diabetes developing in children as young as 5 and 8 years of age [2, 3]. The US SEARCH for Diabetes in Youth Study reported that children younger than 10 years comprised 3.6% of newly diagnosed 2 D cases [4]. Similarly, a Canadian study found that 8% of newly diagnosed T2 D children were less than 10 years of age [5]. Overall, the SEARCH study observed a 30.5% rise in T2DM prevalence among youth, with 2.4% of cases occurring in those under 10 years old [6]. Given the signiϐicant` impact of risk factors such as obesity, family history, and ethnicity, T2D should be considered in children with these risk factors regardless of their age or the presence of symptoms [7]. Notably, the risk of pediatric T2D is greatly inϐluenced by obesity, particularly the accumulation of visceral fat, which worsens insulin resistance, a key feature of the disease. Children with a family history of T2 D are also at increased risk. Diabetes Canada recommends screening for T2DM in prepubertal children with three or more risk factors and in pubertal youth with two or more risk factors [8]. A recent study conducted at our center in Bangladesh revealed that 10 (14.7%) of 68 T2 D patients were diagnosed before the age of 10. 9 This study aimed to assess the baseline clinical, demographic, and laboratory characteristics, as well as the glycemic control and treatment approaches for children and adolescents with
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