Type 2 diabetes and metabolic syndrome in youth — structured clinical encounter

Structured encounter testing the approach to a thirteen-year-old boy whose metformin monotherapy for type 2 diabetes is failing: the recognition of the rapid beta-cell decline, the stepwise escalation of pharmacotherapy, the early nephropathy signalled by raised blood pressure and albuminuria, and the family-based and culturally safe communication about a fast, aggressive disease.

structured clinical encounter2 min readVerification in progress

Prompt

A thirteen-year-old boy diagnosed with type 2 diabetes two years ago presents with a rising HbA1c, a raised blood pressure and mildly raised albuminuria despite metformin monotherapy. You are the paediatric registrar working through the escalation of pharmacotherapy, the comorbidity and complication care, and the conversation with the family about a fast, aggressive disease.

Station brief (candidate)

You are the paediatric registrar. A thirteen-year-old boy returns to the diabetes clinic for his routine review. He was diagnosed with type 2 diabetes two years ago and has been taking metformin 1000 milligrams twice daily with intermittent lifestyle adherence. His HbA1c has risen from 6.9 percent at diagnosis to 8.6 percent, his blood pressure is 134 over 88, and his urine albumin-to-creatinine ratio is mildly raised. His father and paternal grandmother both have type 2 diabetes. The team asks you to assess the trajectory, plan the escalation, address the comorbidity, and speak with the family. You have 12 minutes with the team and 5 minutes for examiner discussion. [10]

Paediatrics Fellowship Pro

You have read the opening of this case. The complete unit — every section and its primary-source references — is part of the Paediatrics Fellowship fellowship atlas.

References5Show ledger

[1]Shah AS; Zeitler PS; Wong J; et al ISPAD Clinical Practice Consensus Guidelines 2022: Type 2 diabetes in children and adolescents. Pediatr Diabetes, 2022.PMID 36161685
[8]Laffel LM; Danne T; Klingensmith GJ; et al Efficacy and safety of the SGLT2 inhibitor empagliflozin versus placebo and the DPP-4 inhibitor linagliptin versus placebo in young people with type 2 diabetes (DINAMO): a randomised trial. Lancet Diabetes Endocrinol, 2023.PMID 36738751
[10]Zeitler P, Hirst K, Pyle L, et al. A clinical trial to maintain glycemic control in youth with type 2 diabetes. N Engl J Med, 2012.PMID 22540912
[11]Dabelea D; Stafford JM; Mayer-Davis EJ; et al Association of Type 1 Diabetes vs Type 2 Diabetes Diagnosed During Childhood and Adolescence With Complications During Teenage Years and Young Adulthood. JAMA, 2017.PMID 28245334
[12]Marcus MD; Wilfley DE; El Ghormli L; et al Weight change in the management of youth-onset type 2 diabetes: the TODAY clinical trial experience. Pediatr Obes, 2017.PMID 27161901