BPSU - Type 2 diabetes in children and young people under 17 years of age in the UK and ROI

Surveillance of type two diabetes in children and young people <17 years of age commenced in April 2015. This is a repeat of study from 2005 and the research team hope to identify the incidence of newly diagnosed Type 2 diabetes in children and young people and understand how this has changed over the last ten years since the previous study. The research team also hope to understand the diagnosis and clinical management of the condition alongside associated co-morbidities.

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Lead investigator

Prof Julian Hamilton-ShieldProf J Hamilton-Shield & Dr A Majbar
Bristol Royal Hospital for Children
Upper Maudlin Street
Bristol
BS2 8AE

Project Co-ordinator

Dr Abdalmonem Majbar
Level 6 UHBT Education Centre
Bristol Royal Hospital for Children
Upper Maudlin Street
Bristol
BS2 8AE
 

Overview

There are two main types of diabetes: Type 1 and Type 2. In both types of diabetes, the patient’s blood sugar levels are high because there is not enough insulin, produced by the pancreas, to keep the blood sugar levels normal. In Type 2 diabetes the pancreas still makes insulin but not enough to meet individual’s needs as the person does not respond (‘resistant’) to insulin’s normal action. Too much glucose is made by the liver and cannot move into the cells of the body to be used for making energy.  The pancreas has to work harder to make sufficient insulin to get glucose to go into these cells, but eventually gets worn out from this extra effort.

This study will be investigating Type 2 diabetes diagnosed in children and young people up to 17 years of age. Until recently this condition was not seen in children or adolescents, being a condition seen in adults. However there is growing evidence that the increase in childhood obesity has resulted in cases of Type 2 diabetes being diagnosed in younger age groups.

Case defintinon: Please report any cases of children 0-17 years in the past month presenting with Type 2 diabetes as defined below. The American Diabetes Association criteria for diagnosis of diabetes will be used.

Exclusion criteria
 
Type 1 diabetes (positive auto-antibodies and/or persisting insulin requirement from diagnosis)
Maturity Onset Diabetes of the Young (MODY) – suggested by a three generation, family history suggestive of dominantly inherited diabetes with normal weight
• Diabetes developing in a person with known diabetes associated syndrome such as Prader-Willi, Alstrom or Bardet-Biedl syndromes
A diagnosis of diabetes while on medical therapy with a known diabetogenic medication (e.g., glucocorticoid, L-asparaginase, cyclosporine, tacrolimus, atypical antipsychotic, anticonvulsant)
• Pancreatic failure (such as that after acute pancreatitis or pancreatectomy)
 
Analytic case definition 
 
Any case of confirmed, newly diagnosed Type 2 diabetes using following criteria:
 
Confirmed by the presence of raised insulin level (>132 pmols/litre or equivalent) or raised C peptide level (>600 pmols/litre) 
 
OR
 
The patient is managed off insulin therapy for >9 months in the absence of auto-antibodies typical of Type 1 diabetes.
 
The latter definition is likely to be based on a clinical re-evaluation after diagnosis of diabetes when clinical course suggests a diagnosis other than type 1 diabetes.

Duration

April 2015 to April 2016 (13 months of surveillance). Follow-up until April 2017 (12 month follow-up).

Funding

NIHR grant through the Rare Disease Translational Research Consortium.

Ethical approval

This study has been approved by NRES Committee South West  (REC reference: 14/SW/1143) and has been granted Section 251 HRA-CAG permission (CAG reference: 15/CAG/0102))

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