OBJECTIVE: Type-2 Diabetes Mellitus (T2DM) initially said to be an adult disease is now reported in children in the developed countries because of increased incidence of obesity and sedentary habits associated with lifestyle changes. T2DM was diagnosed based on the absence of ketosis, good beta cell reserve as shown by the C peptide assay, absence of insulin autoantibody, and response to oral hypoglycemic agents. These case reports aim to describe clinical characteristics, management, and social aspects of T2DM in children.
CASE: We reported two cases of T2DM who registered at Sanglah General Hospital Denpasar in 2018. First case, a 12-year old female presented in the hospital with one year history of weight loss. She had increased the appetite, always felt thirsty, and excessive urination. She had also vulvovaginal candidiasis. Her father got diabetes mellitus type 2. Her laboratory results when first time admission as as Random Blood Glucose 292 mg/dL, HbA1C 14.5%, C-Peptide 1.3 ng/mL. Second case, a 10-year old female presented with frequent urination around 6 months before admission mostly at night. She was an obese. She had also onychomycosis. Her mother got gestational diabetes. Her laboratory results when first time admission as Random Blood Glucose 395 mg/dL, HbA1C 10,7%, C-Peptide 2.4 ng/mL. Both of them got therapy of long acting insulin and metformin orally. All of them initially had the same problem in compliance to the medication and lifestyle modification, but they had good psychological aspect.
CONCLUSION: T2DM is being reported in obese children with a family history of DM. Systematic screening and evaluation management of T2DM are important. These include additional focus on lifestyle management and diabetes self-management education and support. For patient with obesity, efforts targeting weight loss, including lifestyle, medication are recommended to prevent the complications.