Paeds Vivas · endocrinology-diabetes-and-growth
Type 2 diabetes and metabolic syndrome in youth — branching viva
Branching viva from the acanthosis clue and the metabolic cluster, through the fourteen-year-old girl with insulin resistance and polycystic ovary syndrome, the thirteen-year-old boy whose metformin is failing, the antibody and C-peptide split between type 2 and type 1, and the comorbidity and complication care that defines the disease as faster and more dangerous than its adult counterpart.
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Study tools
Target exams
RACP General PaediatricsRACP DCEMRCPCH ClinicalRCPSC Pediatrics
Prompt
You are the paediatric registrar in the outpatient clinic and the adolescent medicine service. You are asked to assess three adolescents in succession: a fourteen-year-old girl with dark skin at the neck and irregular periods, a thirteen-year-old boy whose metformin is failing with a rising HbA1c and blood pressure, and a fifteen-year-old with obesity and a high glucose in whom the type is unclear. The examiner releases information in stages.
Station opening
Examiner: "Tell me the single bedside concept that frames every overweight adolescent with acanthosis nigricans, and why it matters." [7]
Strong candidate (must-hit)
- The concept is insulin resistance with progressive beta-cell decline, layered on obesity and the metabolic cluster. Resist insulin and the beta cell drives out more of it, producing the acanthosis, ovarian hyperandrogenism, fatty liver, dyslipidaemia and hypertension that travel together. Exhaust the beta cell and glucose rises. It matters because the disease is faster and more aggressive than adult type 2 diabetes — beta-cell function is already halved at diagnosis and declines about 15 to 20 percent per year — so the acanthosis is a call to assess, not a cosmetic aside. [7] [1]
Weak candidate
- "It is probably just a skin problem — I would refer to dermatology." [7]
References6ShowHide
- [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
- [6]Zimmet P; Alberti KG; Kaufman F; et al The metabolic syndrome in children and adolescents - an IDF consensus report. Pediatr Diabetes, 2007.PMID 17850473
- [7]Maguolo A; Maffeis C Acanthosis nigricans in childhood: A cutaneous marker that should not be underestimated, especially in obese children. Acta Paediatr, 2020.PMID 31560795
- [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