Treating T2D in People of Younger Age in This Day and Age: How Would You Manage These Children and Adolescents With T2D?
PeerVoice
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Apr 30, 2024
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About This Presentation
Maria Craig, MBBS, PhD, FRACP, MMed(ClinEpid) and Timothy Barrett, MB, BS, PhD discuss type 2 diabetes in children and adolescents in this CE activity titled "Treating T2D in People of Younger Age in This Day and Age: How Would You Manage These Children and Adolescents With T2D?" For the f...
Slide Content
PeerVoice
Treating T2D in People of Younger Age in This Day and Age: How Would
You Manage These Children and Adolescents With T2D?
Learning Objectives
Evaluate the efficacy and safety evidence for recommended interventions to
manage type 2 diabetes (T2D) in children and adolescents
Describe age-, disease-, and treatment-related considerations which impact
decision-making in the treatment of T2D in children and adolescents
Propose evidence-based, guideline-recommended management plans for
children and adolescents with T2D
PeerVoice is an EBAC® accredited provider since 2022.
www.peervoice.com/GBR870
Treating T2D in People of Younger Age in This Day and Age: How Would
You Manage These Children and Adolescents With T2D?
Learning Objectives
Evaluate the efficacy and safety evidence for recommended interventions to
manage type 2 diabetes (T2D) in children and adolescents
Describe age-, disease-, and treatment-related considerations which impact
decision-making in the treatment of T2D in children and adolescents
Propose evidence-based, guideline-recommended management plans for
children and adolescents with T2D
PeerVoice is an EBAC® accredited provider since 2022.
www.peervoice.com/GBR870
PeerVoice
Part | of 8: Providing Evidence-Based Care for T2D in Children and Adolescents: What Have We Learned?
Maria Craig, MBBS, PhD, FRACP, MMed(ClinEpid) Timothy Barrett, MB, BS, PhD
Professor of Paediatric Endocrinology Professor of Paediatrics
University of New South Wales and University of Birmingham
University of Sydney (Children's Hospital Clinical School) Honorary Consultant in Paediatric Endocrinology and Diabetes
Senior Staff Specialist in Paediatric Endocrinology Birmingham Women's and Children's Hospital
The Children’s Hospital at Westmead Birmingham, United Kingdom
Westmead, New South Wales, Australia
Copyright © 2010-2024, PeerVoice
Part | of 8: Providing Evidence-Based Care for T2D in Children and Adolescents: What Have We Learned?
Maria Craig, MBBS, PhD, FRACP, MMed(ClinEpid) Timothy Barrett, MB, BS, PhD
Professor of Paediatric Endocrinology Professor of Paediatrics
University of New South Wales and University of Birmingham
University of Sydney (Children's Hospital Clinical School) Honorary Consultant in Paediatric Endocrinology and Diabetes
Senior Staff Specialist in Paediatric Endocrinology Birmingham Women's and Children's Hospital
The Children’s Hospital at Westmead Birmingham, United Kingdom
Westmead, New South Wales, Australia
Copyright © 2010-2024, PeerVoice
PeerVoice
Disclosures
Maria Craig, MBBS, PhD, FRACP, MMed(ClinEpid), has no financial
interests/relationships or affiliations in relation to this activity.
Timothy Barrett, MB, BS, PhD, has a financial interest/relationship or affiliation in
the form of:
Advisory Board for Novo Nordisk A/S.
www.peervoice.com/GBR870 Copyright © 2010-2024, PeerVoice
Disclosures
Maria Craig, MBBS, PhD, FRACP, MMed(ClinEpid), has no financial
interests/relationships or affiliations in relation to this activity.
Timothy Barrett, MB, BS, PhD, has a financial interest/relationship or affiliation in
the form of:
Advisory Board for Novo Nordisk A/S.
www.peervoice.com/GBR870 Copyright © 2010-2024, PeerVoice
PeerVoice
Global Incidence of T2D in Children and Adolescents
2021 Estimated Incidence Rates
(per 100,00)
mo-09
m9
2-29
MM 3-39
M240
No estimate
www.peervoice.com/GBR870 Copyright © 2010-2024, PeerVoice
Global Incidence of T2D in Children and Adolescents
2021 Estimated Incidence Rates
(per 100,00)
mo-09
m9
2-29
MM 3-39
M240
No estimate
www.peervoice.com/GBR870 Copyright © 2010-2024, PeerVoice
PeerVoice
Management Goals
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Management of comorbidities
Diabetes self-management education and
support (DSMES)
Lifestyle modification
Copyright © 2010-2024, Peervoice
Management Goals
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Management of comorbidities
Diabetes self-management education and
support (DSMES)
Lifestyle modification
Copyright © 2010-2024, Peervoice
PeerVoice
TODAY: Primary Outcome and AEs
1 —— Metformin-Rosiglitazone + The AEs were similar across
— Metformin-Lifestyle arms; the most common AE
Motion Alon was Gl disturbance
D 075 4
+ Other common AEs
2
3
3
fi
2
5
sa included anaemia, abnormal
5 $ os liver transaminases,
53 > excessive weight gain,
ge psychological events
Es N=699 Failure Rate, % E
3 a
52 025 À Metformin Alone 517 + Permanent medication
6 Metformin-Rosiglitazone 386 reductions/discontinuations
S Metformin-Lifestyle 466 occurred most often
he o+ r r r because of abnormal liver
o 12 24 36 48 60 transaminases
Time Since Randomisation, mo
www.peervoice.com/GBR870 Copyright © 2010-2024, PeerVoice
TODAY: Primary Outcome and AEs
1 —— Metformin-Rosiglitazone + The AEs were similar across
— Metformin-Lifestyle arms; the most common AE
Motion Alon was Gl disturbance
D 075 4
+ Other common AEs
2
3
3
fi
2
5
sa included anaemia, abnormal
5 $ os liver transaminases,
53 > excessive weight gain,
ge psychological events
Es N=699 Failure Rate, % E
3 a
52 025 À Metformin Alone 517 + Permanent medication
6 Metformin-Rosiglitazone 386 reductions/discontinuations
S Metformin-Lifestyle 466 occurred most often
he o+ r r r because of abnormal liver
o 12 24 36 48 60 transaminases
Time Since Randomisation, mo
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Randomised Phase 3 Trials of GLP-1 RAs for T2D in Young People
(Age Range, y)
NCTO1541215 (Elli NCTO15546182 NCTO2963766 (AWARD-PEDS)?
Treatment Arms | Liraglutide (plus metformin) vs Exenatide vs PBO (5:2) Dulaglutide 0.75 mg vs
(Randomisation) | PBO (plus metformin) (11) Dulaglutide 1.5 mg vs PBO (1:11)
Participants,N | 144 (10 to 17) 83 (10 to <18) 154 (10 to <18)
= BMI >85th percentile
+ HbAlc: 7.0% to 11.0%, in
participants treated with diet
“HbAlc: 6.5% to 11.0% in
participants not taking insulin/SU
+HbAlc: 6.5% to 12.0% in
“BMI >85th percentile
+HbAlc: 6.5% to 9.0%, in
participants treated with diet
o and exercise alone participants taking insulin/SU at | and exercise alone
+ HbAlc: 6.5% to 1.0% in visit 1 *HbAlc: 6.5% to 11.0% in
participants taking metformin participants taking metformin
(with or without insulin) (with or without basal insulin)
Primary Change from baselineinHbAle | Change from baselineinHbAle | Change from baseline in HbAlc
Outcome level after 26 weeks level after 24 weeks level after 26 weeks
‘Administration |SC injection once daily SC injection once weekly SC injection once weekly
Results Positive Positive Positive
Most Common |: Gl disorders + Gi disorders asus
AEs + Hypoglycaemia - Hypoglycaemia
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Copyright © 2010-2024, PeerVoice
Randomised Phase 3 Trials of GLP-1 RAs for T2D in Young People
(Age Range, y)
NCTO1541215 (Elli NCTO15546182 NCTO2963766 (AWARD-PEDS)?
Treatment Arms | Liraglutide (plus metformin) vs Exenatide vs PBO (5:2) Dulaglutide 0.75 mg vs
(Randomisation) | PBO (plus metformin) (11) Dulaglutide 1.5 mg vs PBO (1:11)
Participants,N | 144 (10 to 17) 83 (10 to <18) 154 (10 to <18)
= BMI >85th percentile
+ HbAlc: 7.0% to 11.0%, in
participants treated with diet
“HbAlc: 6.5% to 11.0% in
participants not taking insulin/SU
+HbAlc: 6.5% to 12.0% in
“BMI >85th percentile
+HbAlc: 6.5% to 9.0%, in
participants treated with diet
o and exercise alone participants taking insulin/SU at | and exercise alone
+ HbAlc: 6.5% to 1.0% in visit 1 *HbAlc: 6.5% to 11.0% in
participants taking metformin participants taking metformin
(with or without insulin) (with or without basal insulin)
Primary Change from baselineinHbAle | Change from baselineinHbAle | Change from baseline in HbAlc
Outcome level after 26 weeks level after 24 weeks level after 26 weeks
‘Administration |SC injection once daily SC injection once weekly SC injection once weekly
Results Positive Positive Positive
Most Common |: Gl disorders + Gi disorders asus
AEs + Hypoglycaemia - Hypoglycaemia
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Copyright © 2010-2024, PeerVoice
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Abbreviations and References
Global Incidence of T2D in Children and Adolescents
Abbreviation(s): T2D: type 2 diabetes.
Reference(s): Wu H et al. Diabetes Res Clin Pract. 2022;185:109785.
Goals in the Management of T2D in Children and Adolescents
Reference(s): Zeitler P et al. Pediatr Diabetes. 2018;19(suppl 27):28-46.
TODAY: Primary Outcome and AEs
Abbreviation(s): AE: adverse event; Gl: gastrointestinal.
Reference(s): TODAY Study Group; Zeitler P et al. N Engl J Med. 2012;366:2247-2256.
TODAY Study Group. Diabetes Care. 2013;36:1765-1771.
Randomised Phase 3 Trials of GLP-1 RAs for T2D in Young People
Abbreviation(s): BMi: body mass index; GLP-1 RA: glucagon-like peptide-1 receptor agonist; HbAlc: glycated
haemoglobin; PBO: placebo; SU: sulphonylurea
Reference(s): 1. Tamborlane WV et al; Ellipse Trial Investigators. N Engl J Med. 2019;381:637-646.
2. Tamborlane WV et al. Diabetes Care. 2022;45:1833-1840.
3. Arslanian SA et al; AWARD-PEDS investigators. N Engl J Med. 2022;387:433-443.
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Abbreviations and References
Global Incidence of T2D in Children and Adolescents
Abbreviation(s): T2D: type 2 diabetes.
Reference(s): Wu H et al. Diabetes Res Clin Pract. 2022;185:109785.
Goals in the Management of T2D in Children and Adolescents
Reference(s): Zeitler P et al. Pediatr Diabetes. 2018;19(suppl 27):28-46.
TODAY: Primary Outcome and AEs
Abbreviation(s): AE: adverse event; Gl: gastrointestinal.
Reference(s): TODAY Study Group; Zeitler P et al. N Engl J Med. 2012;366:2247-2256.
TODAY Study Group. Diabetes Care. 2013;36:1765-1771.
Randomised Phase 3 Trials of GLP-1 RAs for T2D in Young People
Abbreviation(s): BMi: body mass index; GLP-1 RA: glucagon-like peptide-1 receptor agonist; HbAlc: glycated
haemoglobin; PBO: placebo; SU: sulphonylurea
Reference(s): 1. Tamborlane WV et al; Ellipse Trial Investigators. N Engl J Med. 2019;381:637-646.
2. Tamborlane WV et al. Diabetes Care. 2022;45:1833-1840.
3. Arslanian SA et al; AWARD-PEDS investigators. N Engl J Med. 2022;387:433-443.
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Part 2 of 8: A Case of Newly Diagnosed T2D in Adolescence: Designing Treatment Plans and Promoting Adherence
Maria Craig, MBBS, PhD, FRACP, MMed(ClinEpid) Timothy Barrett, MB, BS, PhD
Professor of Paediatric Endocrinology Professor of Paediatrics
University of New South Wales and University of Birmingham
University of Sydney (Children's Hospital Clinical School) Honorary Consultant in Paediatric Endocrinology and Diabetes
Senior Staff Specialist in Paediatric Endocrinology Birmingham Women's and Children's Hospital
The Children's Hospital at Westmead Birmingham, United Kingdom
Westmead, New South Wales, Australia
Copyright © 2010-2024, PeerVoice
Part 2 of 8: A Case of Newly Diagnosed T2D in Adolescence: Designing Treatment Plans and Promoting Adherence
Maria Craig, MBBS, PhD, FRACP, MMed(ClinEpid) Timothy Barrett, MB, BS, PhD
Professor of Paediatric Endocrinology Professor of Paediatrics
University of New South Wales and University of Birmingham
University of Sydney (Children's Hospital Clinical School) Honorary Consultant in Paediatric Endocrinology and Diabetes
Senior Staff Specialist in Paediatric Endocrinology Birmingham Women's and Children's Hospital
The Children's Hospital at Westmead Birmingham, United Kingdom
Westmead, New South Wales, Australia
Copyright © 2010-2024, PeerVoice
PeerVoice
Disclosures
Maria Craig, MBBS, PhD, FRACP, MMed(ClinEpid), has no financial
interests/relationships or affiliations in relation to this activity.
Timothy Barrett, MB, BS, PhD, has a financial interest/relationship or affiliation in
the form of:
Advisory Board for Novo Nordisk A/S.
www.peervoice.com/GBR870 Copyright © 2010-2024, PeerVoice
Disclosures
Maria Craig, MBBS, PhD, FRACP, MMed(ClinEpid), has no financial
interests/relationships or affiliations in relation to this activity.
Timothy Barrett, MB, BS, PhD, has a financial interest/relationship or affiliation in
the form of:
Advisory Board for Novo Nordisk A/S.
www.peervoice.com/GBR870 Copyright © 2010-2024, PeerVoice
PeerVoice
Ameer: 14-Year-Old Boy With Mild Osmotic Sympt:
+ Mild osmotic symptoms + HbAlc: 8.0% (64 mmol/mol)
+ Acanthosis nigricans + Weight: 108 kg
+ Gout with raised urate
Medical and Social History
+ ADHD
+ Mother has obesity and IGT
+ Youngest child of monoparental family from deprived area
+ Ethnicity: Pakistani
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Ameer: 14-Year-Old Boy With Mild Osmotic Sympt:
+ Mild osmotic symptoms + HbAlc: 8.0% (64 mmol/mol)
+ Acanthosis nigricans + Weight: 108 kg
+ Gout with raised urate
Medical and Social History
+ ADHD
+ Mother has obesity and IGT
+ Youngest child of monoparental family from deprived area
+ Ethnicity: Pakistani
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Ameer: Initial Managem
+ Lifestyle advice
+ Metformin
+ Allopurinol
+ HbAlc decrease: 8.0%
adherent to treatment
MA Follow-Up After 8 Months
T2D management
Gout management
to 6.8% (51 mmol/mol)
+ Weight decrease: 108 kg to 103 kg
+ Initially he was very compliant and helpful, but he later stopped being
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Ameer: Initial Managem
+ Lifestyle advice
+ Metformin
+ Allopurinol
+ HbAlc decrease: 8.0%
adherent to treatment
MA Follow-Up After 8 Months
T2D management
Gout management
to 6.8% (51 mmol/mol)
+ Weight decrease: 108 kg to 103 kg
+ Initially he was very compliant and helpful, but he later stopped being
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Feeling different to other people who don't
Psychological have diabetes
Barriers
Sense that diabetes is a rival that they have
to fight against
Trying to push away negative thoughts and
feelings, but angry outbursts when reminded
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Feeling different to other people who don't
Psychological have diabetes
Barriers
Sense that diabetes is a rival that they have
to fight against
Trying to push away negative thoughts and
feelings, but angry outbursts when reminded
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Ameer: Managing Nonadherence
Conflicting stories about
oneself
To feel in better control of
diabetes without being in
conflict
Clinical psychology
support and intensive
involvement of diabetes
team
Intervention
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Ameer: Managing Nonadherence
Conflicting stories about
oneself
To feel in better control of
diabetes without being in
conflict
Clinical psychology
support and intensive
involvement of diabetes
team
Intervention
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Abbreviations and References
Ameer: 14-Year-Old Boy With Mild Osmotic Symptoms
Abbreviation(s): ADHD: attention-deficit/hyperactivity disorder; HbAle: glycated haemoglobin; IGT: impaired glucose
tolerance.
Reference(s imothy Barrett, MB, BS, PhD; March 2024.
BBC Panorama: Diabetes, the Hidden Killer. https://youtu.be/dWhSzQECPMQ. Accessed 26 March 2024.
Ameer: Initial Management
Abbreviation(s): T2D: type 2 diabetes.
Reference(s): Courtesy of Timothy Barrett, MB, BS, PhD; March 2024.
Psychological Barriers to Diabetes Management in Young People
ourtesy of Timothy Barrett, MB, BS, PhD; March 2024.
Reference(s):
Ameer: Managing Nonadherence
Reference(s): Courtesy of Timothy Barrett, MB, BS, PhD; March 2024.
de Wit M et al. Pediatr Diabetes. 2022;23:1373-1389.
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Abbreviations and References
Ameer: 14-Year-Old Boy With Mild Osmotic Symptoms
Abbreviation(s): ADHD: attention-deficit/hyperactivity disorder; HbAle: glycated haemoglobin; IGT: impaired glucose
tolerance.
Reference(s imothy Barrett, MB, BS, PhD; March 2024.
BBC Panorama: Diabetes, the Hidden Killer. https://youtu.be/dWhSzQECPMQ. Accessed 26 March 2024.
Ameer: Initial Management
Abbreviation(s): T2D: type 2 diabetes.
Reference(s): Courtesy of Timothy Barrett, MB, BS, PhD; March 2024.
Psychological Barriers to Diabetes Management in Young People
ourtesy of Timothy Barrett, MB, BS, PhD; March 2024.
Reference(s):
Ameer: Managing Nonadherence
Reference(s): Courtesy of Timothy Barrett, MB, BS, PhD; March 2024.
de Wit M et al. Pediatr Diabetes. 2022;23:1373-1389.
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Part 3 of 8: A Case of Newly Diagnosed T2D in Childhood: Recognising the Challenges and
Risks of Chronic Complications
Maria Craig, MBBS, PhD, FRACP, MMed(ClinEpid) Timothy Barrett, MB, BS, PhD
Professor of Paediatric Endocrinology Professor of Paediatrics
University of New South Wales and University of Birmingham
University of Sydney (Children's Hospital Clinical School) Honorary Consultant in Paediatric Endocrinology and Diabetes
Senior Staff Specialist in Paediatric Endocrinology Birmingham Women's and Children's Hospital
The Children’s Hospital at Westmead Birmingham, United Kingdom
Westmead, New South Wales, Australia
Copyright © 2010-2024, PeerVoice
Part 3 of 8: A Case of Newly Diagnosed T2D in Childhood: Recognising the Challenges and
Risks of Chronic Complications
Maria Craig, MBBS, PhD, FRACP, MMed(ClinEpid) Timothy Barrett, MB, BS, PhD
Professor of Paediatric Endocrinology Professor of Paediatrics
University of New South Wales and University of Birmingham
University of Sydney (Children's Hospital Clinical School) Honorary Consultant in Paediatric Endocrinology and Diabetes
Senior Staff Specialist in Paediatric Endocrinology Birmingham Women's and Children's Hospital
The Children’s Hospital at Westmead Birmingham, United Kingdom
Westmead, New South Wales, Australia
Copyright © 2010-2024, PeerVoice
PeerVoice
Disclosures
Maria Craig, MBBS, PhD, FRACP, MMed(ClinEpid), has no financial
interests/relationships or affiliations in relation to this activity.
Timothy Barrett, MB, BS, PhD, has a financial interest/relationship or affiliation in
the form of:
Advisory Board for Novo Nordisk A/S.
www.peervoice.com/GBR870 Copyright © 2010-2024, PeerVoice
Disclosures
Maria Craig, MBBS, PhD, FRACP, MMed(ClinEpid), has no financial
interests/relationships or affiliations in relation to this activity.
Timothy Barrett, MB, BS, PhD, has a financial interest/relationship or affiliation in
the form of:
Advisory Board for Novo Nordisk A/S.
www.peervoice.com/GBR870 Copyright © 2010-2024, PeerVoice
PeerVoice
Sar.
+ Polydipsia + HbAlc: 11.0% (97 mmol/mol)
+ BGL: 14 mmol/L + GAD and ICA testing: negative
Medical and Social History
+ Obesity
+ Family history of diabetes
+ Ethnicity: Pakistani
+ Family: Psychological issues
+ Mother: Reluctant to accept diagnosis; diagnosed with T2D at same time
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Sar.
+ Polydipsia + HbAlc: 11.0% (97 mmol/mol)
+ BGL: 14 mmol/L + GAD and ICA testing: negative
Medical and Social History
+ Obesity
+ Family history of diabetes
+ Ethnicity: Pakistani
+ Family: Psychological issues
+ Mother: Reluctant to accept diagnosis; diagnosed with T2D at same time
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Sarah: Initial Management
—— Historical Management
P pea exerce Smelter. _ HbAlc decrease: 11.0% to 8.0% (64 mmol/mol)
+ Metformin Nonadherence plc increase: 8.0% to 10.0% (86 mmol/mol)
—— Current Management
+ Diet and exercise advice
+ Metformin
+ Insulin
+ Psychological support
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Sarah: Initial Management
—— Historical Management
P pea exerce Smelter. _ HbAlc decrease: 11.0% to 8.0% (64 mmol/mol)
+ Metformin Nonadherence plc increase: 8.0% to 10.0% (86 mmol/mol)
—— Current Management
+ Diet and exercise advice
+ Metformin
+ Insulin
+ Psychological support
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TODA
Lifelong Diabetes:
15-Y Cumulative
Incidence
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Kidney disease: 55%
Dyslipidaemia: 52%
Neuropathy: 32%
Any microvascular disease: 80%
Copyright © 2010-2024, PeerVoice
TODA
Lifelong Diabetes:
15-Y Cumulative
Incidence
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Kidney disease: 55%
Dyslipidaemia: 52%
Neuropathy: 32%
Any microvascular disease: 80%
Copyright © 2010-2024, PeerVoice
PeerVoice
Abbreviations and References
Sarah: 8-Year-Old Girl With Obesity
Abbreviation(s): BGL: blood glucose level; GAD: glutamic acid decarboxylase; HbAlc: glycated haemoglobin; ICA: islet
cell antibodies; T2D: type 2 diabetes.
Reference(s): Courtesy of Timothy Barrett, MB, BS, PhD; March 2024.
Sarah: Initial Management
Reference(s): Courtesy of Timothy Barrett, MB, BS, PhD; March 2024,
TODAY: Long-Term Impact of Childhood T2D
Reference(s): TODAY Study Group; Bjornstad P et al. N Eng! J Med. 2021:385:416-426.
www.peervoice.com/GBR870 Copyright © 2010-2024, PeerVoice
Abbreviations and References
Sarah: 8-Year-Old Girl With Obesity
Abbreviation(s): BGL: blood glucose level; GAD: glutamic acid decarboxylase; HbAlc: glycated haemoglobin; ICA: islet
cell antibodies; T2D: type 2 diabetes.
Reference(s): Courtesy of Timothy Barrett, MB, BS, PhD; March 2024.
Sarah: Initial Management
Reference(s): Courtesy of Timothy Barrett, MB, BS, PhD; March 2024,
TODAY: Long-Term Impact of Childhood T2D
Reference(s): TODAY Study Group; Bjornstad P et al. N Eng! J Med. 2021:385:416-426.
www.peervoice.com/GBR870 Copyright © 2010-2024, PeerVoice
PeerVoice
Part 4 of 8: A Case of Newly Diagnosed T2D in Late Childhood: Managing HHS and Reducing the Risk of Recurrence
Maria Craig, MBBS, PhD, FRACP, MMed(ClinEpid) Timothy Barrett, MB, BS, PhD
Professor of Paediatric Endocrinology Professor of Paediatrics
University of New South Wales and University of Birmingham
University of Sydney (Children's Hospital Clinical School) Honorary Consultant in Paediatric Endocrinology and Diabetes
Senior Staff Specialist in Paediatric Endocrinology Birmingham Women's and Children's Hospital
The Children's Hospital at Westmead Birmingham, United Kingdom
Westmead, New South Wales, Australia
Copyright © 2010-2024, PeerVoice
Part 4 of 8: A Case of Newly Diagnosed T2D in Late Childhood: Managing HHS and Reducing the Risk of Recurrence
Maria Craig, MBBS, PhD, FRACP, MMed(ClinEpid) Timothy Barrett, MB, BS, PhD
Professor of Paediatric Endocrinology Professor of Paediatrics
University of New South Wales and University of Birmingham
University of Sydney (Children's Hospital Clinical School) Honorary Consultant in Paediatric Endocrinology and Diabetes
Senior Staff Specialist in Paediatric Endocrinology Birmingham Women's and Children's Hospital
The Children's Hospital at Westmead Birmingham, United Kingdom
Westmead, New South Wales, Australia
Copyright © 2010-2024, PeerVoice
PeerVoice
Disclosures
Maria Craig, MBBS, PhD, FRACP, MMed(ClinEpid), has no financial
interests/relationships or affiliations in relation to this activity.
Timothy Barrett, MB, BS, PhD, has a financial interest/relationship or affiliation in
the form of:
Advisory Board for Novo Nordisk A/S.
www.peervoice.com/GBR870 Copyright © 2010-2024, PeerVoice
Disclosures
Maria Craig, MBBS, PhD, FRACP, MMed(ClinEpid), has no financial
interests/relationships or affiliations in relation to this activity.
Timothy Barrett, MB, BS, PhD, has a financial interest/relationship or affiliation in
the form of:
Advisory Board for Novo Nordisk A/S.
www.peervoice.com/GBR870 Copyright © 2010-2024, PeerVoice
PeerVoice
iabetic Ketoacidosis
Hyperglycaemia and ketoacidosis
~6% to 10% of individuals with newly diagnosed T2D
Clinical signs include dehydration, deep sighing respiration, smell of ketones,
drowsiness
Hyperglycaemic Hyperosmolar Syndrome (HHS).
+ Hyperglycaemia and hyperosmolarity without significant ketosis
+ ~2% of individuals with newly diagnosed T2D
+ Manifests with gradually increasing polyuria and polydipsia that may go
unrecognised, resulting in profound dehydration and electrolyte losses at the
time of presentation
+ Higher propensity for complications and mortality than that observed in DKA
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iabetic Ketoacidosis
Hyperglycaemia and ketoacidosis
~6% to 10% of individuals with newly diagnosed T2D
Clinical signs include dehydration, deep sighing respiration, smell of ketones,
drowsiness
Hyperglycaemic Hyperosmolar Syndrome (HHS).
+ Hyperglycaemia and hyperosmolarity without significant ketosis
+ ~2% of individuals with newly diagnosed T2D
+ Manifests with gradually increasing polyuria and polydipsia that may go
unrecognised, resulting in profound dehydration and electrolyte losses at the
time of presentation
+ Higher propensity for complications and mortality than that observed in DKA
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Year-Old Girl With T2D and Suspected Ketoacidosis
o, zu
+» Polyuria and polydipsia for + BMI: >25th percentile*
past 2 wk + Glasgow Coma Score: Low
+ Weight loss
Medical and Social History
+ Premorbid factors: None
+ Ethnicity: South Asian
* Diet: High daily intake of sugary energy drinks
* BMI charts for individuals from Asian descent differ from those of European descent.
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Year-Old Girl With T2D and Suspected Ketoacidosis
o, zu
+» Polyuria and polydipsia for + BMI: >25th percentile*
past 2 wk + Glasgow Coma Score: Low
+ Weight loss
Medical and Social History
+ Premorbid factors: None
+ Ethnicity: South Asian
* Diet: High daily intake of sugary energy drinks
* BMI charts for individuals from Asian descent differ from those of European descent.
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PeerVoice
A nitial Manageme!
Laboratory Tests
+ Urine dipstick > glucose ++++; ketones +
» BGL: 56 mmol/L ’
+ pH: 7.35 id
» Base excess: -4.5 mmol/L
Nat: 135 mmol/L
Urea: 13.5 mmol/L
Plasma osmolarity:
376 mOsmol/kg
Historic Emergency
A Management for DKA
+ 24-h rehydration with 0.1 units/kg/h IV insulin >
Her blood glucose fell more rapidly than desired
+» Maintenance insulin: (30%) 0.9 units/kg/day
+ GAD 65 antibody: negative
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A nitial Manageme!
Laboratory Tests
+ Urine dipstick > glucose ++++; ketones +
» BGL: 56 mmol/L ’
+ pH: 7.35 id
» Base excess: -4.5 mmol/L
Nat: 135 mmol/L
Urea: 13.5 mmol/L
Plasma osmolarity:
376 mOsmol/kg
Historic Emergency
A Management for DKA
+ 24-h rehydration with 0.1 units/kg/h IV insulin >
Her blood glucose fell more rapidly than desired
+» Maintenance insulin: (30%) 0.9 units/kg/day
+ GAD 65 antibody: negative
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Management of HHS in T2D
Bolus 0.9:
saline at 20
mL/kg; repeat
until perfusion
established
-Maintenance
fluids + deficit
replacement
over 24-48 h
using 0.45%:
0.75% saline
output
HHS:
-Start insulin
infusion when
BG no longer
-IV regular
insulin 0.025-
0.05 unit/kg/h
Hyperosmolar
DKA:
Start insulin 1h
after starting IV
flui
IV regular insulin
05-010
unit/kg/h
depending on
acidosis
Copyright © 2010-2024, PeerVoice
Management of HHS in T2D
Bolus 0.9:
saline at 20
mL/kg; repeat
until perfusion
established
-Maintenance
fluids + deficit
replacement
over 24-48 h
using 0.45%:
0.75% saline
output
HHS:
-Start insulin
infusion when
BG no longer
-IV regular
insulin 0.025-
0.05 unit/kg/h
Hyperosmolar
DKA:
Start insulin 1h
after starting IV
flui
IV regular insulin
05-010
unit/kg/h
depending on
acidosis
Copyright © 2010-2024, PeerVoice
PeerVoice
Abbreviations and References
HHS: A Serious Metabolic Complication of T2D in Children
Abbreviation(s): T2D: type 2 diabetes.
Reference(s): Glaser N et al. Pediatr Diabetes. 2022;23:835-856.
Asha: 12-Year-Old Girl With T2D and Suspected Ketoacidosis
Abbreviation(s): BMI: body mass index.
Reference(s): Courtesy of Timothy Barrett, MB, BS, PhD; March 2024,
Kershaw MJ et al. Diabet Med. 2005;22:645-647.
Asha: Initial Management
Abbreviation(s): BGL: blood glucose level; GAD: glutamic acid decarboxylase.
Reference(s): Courtesy of Timothy Barrett, MB, BS, PhD;
Kershaw MJ et al. Diabet Med. 2005;22:645-647.
Management of HHS in T2D
Reference(s): Glaser N et al. Pediatr Diabetes. 2022;23:835-856.
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Abbreviations and References
HHS: A Serious Metabolic Complication of T2D in Children
Abbreviation(s): T2D: type 2 diabetes.
Reference(s): Glaser N et al. Pediatr Diabetes. 2022;23:835-856.
Asha: 12-Year-Old Girl With T2D and Suspected Ketoacidosis
Abbreviation(s): BMI: body mass index.
Reference(s): Courtesy of Timothy Barrett, MB, BS, PhD; March 2024,
Kershaw MJ et al. Diabet Med. 2005;22:645-647.
Asha: Initial Management
Abbreviation(s): BGL: blood glucose level; GAD: glutamic acid decarboxylase.
Reference(s): Courtesy of Timothy Barrett, MB, BS, PhD;
Kershaw MJ et al. Diabet Med. 2005;22:645-647.
Management of HHS in T2D
Reference(s): Glaser N et al. Pediatr Diabetes. 2022;23:835-856.
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PeerVoice
Part 5 of 8: A Case of Uncontrolled T2D Across Childhood and Adolescenc:
Recognising Red Flags and Considering Additional interventions
| |
Maria Craig, MBBS, PhD, FRACP, MMed(ClinEpid) Timothy Barrett, MB, BS, PhD
Professor of Paediatric Endocrinology Professor of Paediatrics
University of New South Wales and University of Birmingham
University of Sydney (Children's Hospital Clinical School) Honorary Consultant in Paediatric Endocrinology and Diabetes
Senior Staff Specialist in Paediatric Endocrinology Birmingham Women's and Children's Hospital
The Children's Hospital at Westmead Birmingham, United Kingdom
Westmead, New South Wales, Australia
Copyright © 2010-2024, PeerVoice
Part 5 of 8: A Case of Uncontrolled T2D Across Childhood and Adolescenc:
Recognising Red Flags and Considering Additional interventions
| |
Maria Craig, MBBS, PhD, FRACP, MMed(ClinEpid) Timothy Barrett, MB, BS, PhD
Professor of Paediatric Endocrinology Professor of Paediatrics
University of New South Wales and University of Birmingham
University of Sydney (Children's Hospital Clinical School) Honorary Consultant in Paediatric Endocrinology and Diabetes
Senior Staff Specialist in Paediatric Endocrinology Birmingham Women's and Children's Hospital
The Children's Hospital at Westmead Birmingham, United Kingdom
Westmead, New South Wales, Australia
Copyright © 2010-2024, PeerVoice
PeerVoice
Disclosures
Maria Craig, MBBS, PhD, FRACP, MMed(ClinEpid), has no financial
interests/relationships or affiliations in relation to this activity.
Timothy Barrett, MB, BS, PhD, has a financial interest/relationship or affiliation in
the form of:
Advisory Board for Novo Nordisk A/S.
www.peervoice.com/GBR870 Copyright © 2010-2024, PeerVoice
Disclosures
Maria Craig, MBBS, PhD, FRACP, MMed(ClinEpid), has no financial
interests/relationships or affiliations in relation to this activity.
Timothy Barrett, MB, BS, PhD, has a financial interest/relationship or affiliation in
the form of:
Advisory Board for Novo Nordisk A/S.
www.peervoice.com/GBR870 Copyright © 2010-2024, PeerVoice
PeerVoice
Linjin:
14-Year-Old Girl With History of Overweigh
A
Medical History
AL, / - Ace 7 presented to ED > BMI: >95th percentile; no intervention or follow-up
+ Age 10: Referral > Acanthosis nigricans; BMI: >95th percentile; MASH and IGT
(2-h glucose: 8.3 mmol/L); no symptoms of T2D
- Recommendations for lifestyle modifications (exercise and diet)
+ Age 14: Initially responded to lifestyle modification > BMI: 86th percentile;
HbAlc: 5.5% (37 mmol/mol)
—— Family and Social History
+ No family history of T2D + Diet: High-carb (rice, noodles)
+ Parents with overweight + Lifestyle: Minimal exercise
+ Ethnicity: Chinese
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Linjin:
14-Year-Old Girl With History of Overweigh
A
Medical History
AL, / - Ace 7 presented to ED > BMI: >95th percentile; no intervention or follow-up
+ Age 10: Referral > Acanthosis nigricans; BMI: >95th percentile; MASH and IGT
(2-h glucose: 8.3 mmol/L); no symptoms of T2D
- Recommendations for lifestyle modifications (exercise and diet)
+ Age 14: Initially responded to lifestyle modification > BMI: 86th percentile;
HbAlc: 5.5% (37 mmol/mol)
—— Family and Social History
+ No family history of T2D + Diet: High-carb (rice, noodles)
+ Parents with overweight + Lifestyle: Minimal exercise
+ Ethnicity: Chinese
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iagnosis of T2D at the Age of 16
¡a Presentation
+ BMI: Increased >95th percentile + Mental health issues;
+ HbAlc: 6.9% (52 mmol/mol) lacking motivation
— MES
+ Initiation on metformin XR: 500 mg graded up to 2 g
+ Significant mental health support
Follow-Up
+ HbAlc decreased: 6.9% to 6.3% (45 mmol/mol)
+ Family is exploring addition of semaglutide to treatment regimen; currently does
not meet criteria in Australia (approved only when metformin has failed)
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iagnosis of T2D at the Age of 16
¡a Presentation
+ BMI: Increased >95th percentile + Mental health issues;
+ HbAlc: 6.9% (52 mmol/mol) lacking motivation
— MES
+ Initiation on metformin XR: 500 mg graded up to 2 g
+ Significant mental health support
Follow-Up
+ HbAlc decreased: 6.9% to 6.3% (45 mmol/mol)
+ Family is exploring addition of semaglutide to treatment regimen; currently does
not meet criteria in Australia (approved only when metformin has failed)
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PeerVoice
Abbreviations and References
Linjin: 14-Year-Old Girl With History of Overweight
Abbreviation(s): BMI: body mass index; ED: emergency department; HbAlc: glycated haemoglobin; IGT: impaired
glucose tolerance; MASH: metabolic dysfunction-associated steatohepatitis; T2D: type 2 diabetes.
Reference(s): Courtesy of Maria Craig, MBBS, PhD, FRACP, MMed(Cli ); March 2024.
Linjin 2 Years Later: Diagnosis of T2D at the Age of 16
Reference(s): Courtesy of Maria Craig, MBBS, PhD, FRACP, MMed(ClinEpid); March 2024.
www.peervoice.com/GBR870 Copyright © 2010-2024, PeerVoice
Abbreviations and References
Linjin: 14-Year-Old Girl With History of Overweight
Abbreviation(s): BMI: body mass index; ED: emergency department; HbAlc: glycated haemoglobin; IGT: impaired
glucose tolerance; MASH: metabolic dysfunction-associated steatohepatitis; T2D: type 2 diabetes.
Reference(s): Courtesy of Maria Craig, MBBS, PhD, FRACP, MMed(Cli ); March 2024.
Linjin 2 Years Later: Diagnosis of T2D at the Age of 16
Reference(s): Courtesy of Maria Craig, MBBS, PhD, FRACP, MMed(ClinEpid); March 2024.
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PeerVoice
Part 6 of 8: A Case of Uncontrolled T2D in Adolescence: ing Insulin With Oral Therapies
Maria Craig, MBBS, PhD, FRACP, MMed(ClinEpid) Timothy Barrett, MB, BS, PhD
Professor of Paediatric Endocrinology Professor of Paediatrics
University of New South Wales and University of Birmingham
University of Sydney (Children's Hospital Clinical School) Honorary Consultant in Paediatric Endocrinology and Diabetes
Senior Staff Specialist in Paediatric Endocrinology Birmingham Women's and Children's Hospital
The Children's Hospital at Westmead Birmingham, United Kingdom
Westmead, New South Wales, Australia
Copyright © 2010-2024, PeerVoice
Part 6 of 8: A Case of Uncontrolled T2D in Adolescence: ing Insulin With Oral Therapies
Maria Craig, MBBS, PhD, FRACP, MMed(ClinEpid) Timothy Barrett, MB, BS, PhD
Professor of Paediatric Endocrinology Professor of Paediatrics
University of New South Wales and University of Birmingham
University of Sydney (Children's Hospital Clinical School) Honorary Consultant in Paediatric Endocrinology and Diabetes
Senior Staff Specialist in Paediatric Endocrinology Birmingham Women's and Children's Hospital
The Children's Hospital at Westmead Birmingham, United Kingdom
Westmead, New South Wales, Australia
Copyright © 2010-2024, PeerVoice
PeerVoice
Disclosures
Maria Craig, MBBS, PhD, FRACP, MMed(ClinEpid), has no financial
interests/relationships or affiliations in relation to this activity.
Timothy Barrett, MB, BS, PhD, has a financial interest/relationship or affiliation in
the form of:
Advisory Board for Novo Nordisk A/S.
www.peervoice.com/GBR870 Copyright © 2010-2024, PeerVoice
Disclosures
Maria Craig, MBBS, PhD, FRACP, MMed(ClinEpid), has no financial
interests/relationships or affiliations in relation to this activity.
Timothy Barrett, MB, BS, PhD, has a financial interest/relationship or affiliation in
the form of:
Advisory Board for Novo Nordisk A/S.
www.peervoice.com/GBR870 Copyright © 2010-2024, PeerVoice
PeerVoice
Rob: 7-Year-Old Boy Diagnosed With T2D and HHS
<=,
+ Drowsy
+ >10% dehydrated
+ Acanthosis nigricans
- BMI >97th percentile
Medical, Family, and Social
= History
Polydipsia and polyuria |. past 3 mo
Weight loss (5 kg)
Drinking >10 fizzy drinks/day
+ Down syndrome
No family history of diabetes
+ Ethnicity: Middle Eastern
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aboratory Tests
Blood glucose: 112 mmol/L
HbAlc: 10.4% (90 mmol/mol)
pH: 7.29
Bicarbonate: 14 mmol/L
+ Na+: 135 mmol/L (corrected 179)
+ K+: 3.5 mmol/L
+ Urea: 17 mmol/L
+ Creatinine: 250 pmol/L
— J jagno: —
+ T2D with HHS
m/GBR870
Copyright © 2010-2024, PeerVoice
Rob: 7-Year-Old Boy Diagnosed With T2D and HHS
<=,
+ Drowsy
+ >10% dehydrated
+ Acanthosis nigricans
- BMI >97th percentile
Medical, Family, and Social
= History
Polydipsia and polyuria |. past 3 mo
Weight loss (5 kg)
Drinking >10 fizzy drinks/day
+ Down syndrome
No family history of diabetes
+ Ethnicity: Middle Eastern
www.peervoice.cor
aboratory Tests
Blood glucose: 112 mmol/L
HbAlc: 10.4% (90 mmol/mol)
pH: 7.29
Bicarbonate: 14 mmol/L
+ Na+: 135 mmol/L (corrected 179)
+ K+: 3.5 mmol/L
+ Urea: 17 mmol/L
+ Creatinine: 250 pmol/L
— J jagno: —
+ T2D with HHS
m/GBR870
Copyright © 2010-2024, PeerVoice
PeerVoice
Rob: HHS and Follow-Up Manageme
— Initial Management
+ For HHS: Careful fluid management > insulin infusion C-peptide:
0.56 nmol/L (range, 0.2-0.65)
+ Insulin requirements: 0.3 units/kg/d on discharge
Follow-Up Management
+ Ongoing weight gain > added metformin XR
+ Continuation of insulin
+ Family struggled to attend appointments, but communicated regularly
with diabetes team
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Rob: HHS and Follow-Up Manageme
— Initial Management
+ For HHS: Careful fluid management > insulin infusion C-peptide:
0.56 nmol/L (range, 0.2-0.65)
+ Insulin requirements: 0.3 units/kg/d on discharge
Follow-Up Management
+ Ongoing weight gain > added metformin XR
+ Continuation of insulin
+ Family struggled to attend appointments, but communicated regularly
with diabetes team
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PeerVoice
istoric HbAlc Values
ic), %
HbAle (Cli
www.peervoice.com/GBR870
Age, y
+ HbAlc: 8.2%
+ Weight: 130 kg
Age 18 I
Copyright © 2010-2024, Peervoice
istoric HbAlc Values
ic), %
HbAle (Cli
www.peervoice.com/GBR870
Age, y
+ HbAlc: 8.2%
+ Weight: 130 kg
Age 18 I
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PeerVoice
Abbreviations and References
Rob: 7-Year-Old Boy Diagnosed With T2D and HHS
Abbreviation(s): BMI: body mass index; HbAlc: glycated haemoglobin; HHS: hyperglycaemic hyperosmolar syndrome;
T2D: type 2 diabetes.
Reference(s): Courtesy of Maria Craig, MBBS, PhD, FRACP, MMed(ClinEpid); March 2024.
Rob: HHS and Follow-Up Management
Reference(s): Courtesy of Maria Craig, MBBS, PhD, FRACP, MMed(ClinEpid); March 2024.
Rob: Historic HbAlc Values
Reference(s): Courtesy of Maria Craig, MBBS, PhD, FRACP, MMed(ClinEpid); March 2024.
www.peervoice.com/GBR870 Copyright © 2010-2024, PeerVoice
Abbreviations and References
Rob: 7-Year-Old Boy Diagnosed With T2D and HHS
Abbreviation(s): BMI: body mass index; HbAlc: glycated haemoglobin; HHS: hyperglycaemic hyperosmolar syndrome;
T2D: type 2 diabetes.
Reference(s): Courtesy of Maria Craig, MBBS, PhD, FRACP, MMed(ClinEpid); March 2024.
Rob: HHS and Follow-Up Management
Reference(s): Courtesy of Maria Craig, MBBS, PhD, FRACP, MMed(ClinEpid); March 2024.
Rob: Historic HbAlc Values
Reference(s): Courtesy of Maria Craig, MBBS, PhD, FRACP, MMed(ClinEpid); March 2024.
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PeerVoice
Part 7 of 8: A Case of Uncontrolled T2D in a Young Person: Optimising Long-Term Management
Across Childhood and Adolescence
Maria Craig, MBBS, PhD, FRACP, MMed(ClinEpid) Timothy Barrett, MB, BS, PhD
Professor of Paediatric Endocrinology Professor of Paediatrics
University of New South Wales and University of Birmingham
University of Sydney (Children's Hospital Clinical School) Honorary Consultant in Paediatric Endocrinology and Diabetes
Senior Staff Specialist in Paediatric Endocrinology Birmingham Women's and Children's Hospital
The Children's Hospital at Westmead Birmingham, United Kingdom
Westmead, New South Wales, Australia
Copyright © 2010-2024, PeerVoice
Part 7 of 8: A Case of Uncontrolled T2D in a Young Person: Optimising Long-Term Management
Across Childhood and Adolescence
Maria Craig, MBBS, PhD, FRACP, MMed(ClinEpid) Timothy Barrett, MB, BS, PhD
Professor of Paediatric Endocrinology Professor of Paediatrics
University of New South Wales and University of Birmingham
University of Sydney (Children's Hospital Clinical School) Honorary Consultant in Paediatric Endocrinology and Diabetes
Senior Staff Specialist in Paediatric Endocrinology Birmingham Women's and Children's Hospital
The Children's Hospital at Westmead Birmingham, United Kingdom
Westmead, New South Wales, Australia
Copyright © 2010-2024, PeerVoice
PeerVoice
Disclosures
Maria Craig, MBBS, PhD, FRACP, MMed(ClinEpid), has no financial
interests/relationships or affiliations in relation to this activity.
Timothy Barrett, MB, BS, PhD, has a financial interest/relationship or affiliation in
the form of:
Advisory Board for Novo Nordisk A/S.
www.peervoice.com/GBR870 Copyright © 2010-2024, PeerVoice
Disclosures
Maria Craig, MBBS, PhD, FRACP, MMed(ClinEpid), has no financial
interests/relationships or affiliations in relation to this activity.
Timothy Barrett, MB, BS, PhD, has a financial interest/relationship or affiliation in
the form of:
Advisory Board for Novo Nordisk A/S.
www.peervoice.com/GBR870 Copyright © 2010-2024, PeerVoice
PeerVoice
+ Presented with symptoms
of diabetes: overweight
+ HbAlc: 9.8% (84 mmol/mol)
+ Mother had T2D; was on
dialysis and died from renal
failure at age 49
+ Ethnicity: Pacific Islander
a: 10-Year-Old Girl Diagnosed W
T2D
Initial Manageme:
Lifestyle intervention
J 1y later (age 11)
HbAlc decrease: 9.8% to 7.9% (63 mmol/mol)
www.peervoice.com/GBR870
+ HbAlc decrease: 7.9% to 6.1% (43 mmol/mol)
Follo:
Referral due to change of living
circumstances
Initiated metformin XR (up to 2 g)
12 mo later
Copyright © 2010-2024, PeerVoice
+ Presented with symptoms
of diabetes: overweight
+ HbAlc: 9.8% (84 mmol/mol)
+ Mother had T2D; was on
dialysis and died from renal
failure at age 49
+ Ethnicity: Pacific Islander
a: 10-Year-Old Girl Diagnosed W
T2D
Initial Manageme:
Lifestyle intervention
J 1y later (age 11)
HbAlc decrease: 9.8% to 7.9% (63 mmol/mol)
www.peervoice.com/GBR870
+ HbAlc decrease: 7.9% to 6.1% (43 mmol/mol)
Follo:
Referral due to change of living
circumstances
Initiated metformin XR (up to 2 g)
12 mo later
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PeerVoice
Follow-Up Medical
= Situation
+ Increasing BMI and HbAlc + Missed clinical appointments
+ Ongoing social issues + Unclear if adhering to treatment
Follow-Up Manageme:
+ Age 13: Metformin and initiation of insulin
+ Age 14: Metformin; insulin, and initiation of dulaglutide; addition of
quinapril due to ACR and hypertension
- Age 15: HbAlc: 10.9% (96 mmol/mol); under intensive MDT care
ging T2D at the Age of 15
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Follow-Up Medical
= Situation
+ Increasing BMI and HbAlc + Missed clinical appointments
+ Ongoing social issues + Unclear if adhering to treatment
Follow-Up Manageme:
+ Age 13: Metformin and initiation of insulin
+ Age 14: Metformin; insulin, and initiation of dulaglutide; addition of
quinapril due to ACR and hypertension
- Age 15: HbAlc: 10.9% (96 mmol/mol); under intensive MDT care
ging T2D at the Age of 15
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Olina: Historic HbAlc Values
Generalised Normal High
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Olina: Historic HbAlc Values
Generalised Normal High
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PeerVoice
Olin storic BMI Values
BMI Values for Girls Aged 2 to 20 Years
Age, y
8 10 2 14 16 18
Percentile,%
24/3 Ina
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Olin storic BMI Values
BMI Values for Girls Aged 2 to 20 Years
Age, y
8 10 2 14 16 18
Percentile,%
24/3 Ina
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Abbreviations and References
Olina: 10-Year-Old Girl Diagnosed With T2D
Abbreviation(s): HbAlc: glycated haemoglobin; T2D: type 2 diabetes.
Reference(s): Courtesy of Maria Craig, MBBS, PhD, FRACP, MMed(ClinEpid); March 2024.
Olina 5 Years Later: Difficulties in Managing T2D at the Age of 15
Abbreviation(s): ACR: albumin-to-creatinine ratio; BMI: body mass index; MDT: multidisciplinary team.
Reference(s): Courtesy of Maria Craig, MBBS, PhD, FRACP, MMed(ClinEpid); March 2024.
Olina: Historic HbAlc Values
Reference(s): Courtesy of Maria Craig, MBBS, PhD, FRACP, MMed(ClinEpid); March 2024.
Olina: Historic BMI Values
Reference(s): Courtesy of Maria Craig, MBBS, PhD, FRACP, MMed(Cli
Centers for Disease Control and Prevention; National Center for Health Statistics: CDC Extended BMI-for-age Growth
Charts. https://www.cde.gov/growthcharts/Extended-BMI-Charts.html. Accessed 26 March 2024.
www.peervoice.com/GBR870 Copyright © 2010-2024, PeerVoice
Abbreviations and References
Olina: 10-Year-Old Girl Diagnosed With T2D
Abbreviation(s): HbAlc: glycated haemoglobin; T2D: type 2 diabetes.
Reference(s): Courtesy of Maria Craig, MBBS, PhD, FRACP, MMed(ClinEpid); March 2024.
Olina 5 Years Later: Difficulties in Managing T2D at the Age of 15
Abbreviation(s): ACR: albumin-to-creatinine ratio; BMI: body mass index; MDT: multidisciplinary team.
Reference(s): Courtesy of Maria Craig, MBBS, PhD, FRACP, MMed(ClinEpid); March 2024.
Olina: Historic HbAlc Values
Reference(s): Courtesy of Maria Craig, MBBS, PhD, FRACP, MMed(ClinEpid); March 2024.
Olina: Historic BMI Values
Reference(s): Courtesy of Maria Craig, MBBS, PhD, FRACP, MMed(Cli
Centers for Disease Control and Prevention; National Center for Health Statistics: CDC Extended BMI-for-age Growth
Charts. https://www.cde.gov/growthcharts/Extended-BMI-Charts.html. Accessed 26 March 2024.
www.peervoice.com/GBR870 Copyright © 2010-2024, PeerVoice
PeerVoice
Part 8 of 8: Improving Care for T2D in Children and Adolescents: What's Now and What's Next?
Maria Craig, MBBS, PhD, FRACP, MMed(ClinEpid) Timothy Barrett, MB, BS, PhD
Professor of Paediatric Endocrinology Professor of Paediatrics
University of New South Wales and University of Birmingham
University of Sydney (Children's Hospital Clinical School) Honorary Consultant in Paediatric Endocrinology and Diabetes
Senior Staff Specialist in Paediatric Endocrinology Birmingham Women's and Children's Hospital
The Children's Hospital at Westmead Birmingham, United Kingdom
Westmead, New South Wales, Australia
Copyright © 2010-2024, PeerVoice
Part 8 of 8: Improving Care for T2D in Children and Adolescents: What's Now and What's Next?
Maria Craig, MBBS, PhD, FRACP, MMed(ClinEpid) Timothy Barrett, MB, BS, PhD
Professor of Paediatric Endocrinology Professor of Paediatrics
University of New South Wales and University of Birmingham
University of Sydney (Children's Hospital Clinical School) Honorary Consultant in Paediatric Endocrinology and Diabetes
Senior Staff Specialist in Paediatric Endocrinology Birmingham Women's and Children's Hospital
The Children's Hospital at Westmead Birmingham, United Kingdom
Westmead, New South Wales, Australia
Copyright © 2010-2024, PeerVoice
PeerVoice
Disclosures
Maria Craig, MBBS, PhD, FRACP, MMed(ClinEpid), has no financial
interests/relationships or affiliations in relation to this activity.
Timothy Barrett, MB, BS, PhD, has a financial interest/relationship or affiliation in
the form of:
Advisory Board for Novo Nordisk A/S.
www.peervoice.com/GBR870 Copyright © 2010-2024, PeerVoice
Disclosures
Maria Craig, MBBS, PhD, FRACP, MMed(ClinEpid), has no financial
interests/relationships or affiliations in relation to this activity.
Timothy Barrett, MB, BS, PhD, has a financial interest/relationship or affiliation in
the form of:
Advisory Board for Novo Nordisk A/S.
www.peervoice.com/GBR870 Copyright © 2010-2024, PeerVoice
PeerVoice
Initial Management of T2D in Children a
| At Diagnosis |
HbAlc >8.5%
269 mmol/mol
HbAlc <8.5%
<69 mmol/mol
No ketosis or acidosis
Ketosis/Acidosis or
HHS
No ketosis or acidosis
Healthy lifestyle (+ Healthy lifestyle > IV insulin until
Metformin: titrated + Metformin: titrated acidosis resolved
to 2 g/day as to 2 g/day as Transition to SQ
tolerated tolerated insulin
* Basal insulin + Healthy lifestyle
(0.25-0.5 u/kg) y | + Basal insulin |
\_ (0.25-0.5 u/kg) /
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Initial Management of T2D in Children a
| At Diagnosis |
HbAlc >8.5%
269 mmol/mol
HbAlc <8.5%
<69 mmol/mol
No ketosis or acidosis
Ketosis/Acidosis or
HHS
No ketosis or acidosis
Healthy lifestyle (+ Healthy lifestyle > IV insulin until
Metformin: titrated + Metformin: titrated acidosis resolved
to 2 g/day as to 2 g/day as Transition to SQ
tolerated tolerated insulin
* Basal insulin + Healthy lifestyle
(0.25-0.5 u/kg) y | + Basal insulin |
\_ (0.25-0.5 u/kg) /
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PeerVoice
Follow-Up Management of T2D in C
Subsequent Treatment
HbAlc <6.5%
<48 mmol/mol
+ Continue healthy
lifestyle
+ Continue metformin
+ Wean insulin, if
applicable
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HbAlc 26.5% to 9%
248 to 74 mmol/mol
Continue healthy lifestyle
Review adherence
Maximise metformin to
2g/day
Add a GLP-1 RA, or
another
antihyperglycaemic
medication (rarely)
+ Continue healthy
lifestyle
Review adherence
Maximise metformin
Add GLP-1RA, or
another
antihyperglycaemic
medication (rarely)
Initiate long-acting
insulin or additional
use of prandial insulin
Copyright © 2010-2024, PeerVoice
Follow-Up Management of T2D in C
Subsequent Treatment
HbAlc <6.5%
<48 mmol/mol
+ Continue healthy
lifestyle
+ Continue metformin
+ Wean insulin, if
applicable
www.peervoice.com/GBR870
HbAlc 26.5% to 9%
248 to 74 mmol/mol
Continue healthy lifestyle
Review adherence
Maximise metformin to
2g/day
Add a GLP-1 RA, or
another
antihyperglycaemic
medication (rarely)
+ Continue healthy
lifestyle
Review adherence
Maximise metformin
Add GLP-1RA, or
another
antihyperglycaemic
medication (rarely)
Initiate long-acting
insulin or additional
use of prandial insulin
Copyright © 2010-2024, PeerVoice
PeerVoice
Investigational Therapies for T2D in Young People
Trial Intervel n Arm Mechanism of Action
SURPAS-PEDS a 4
(NCTO5260021) Tirzepatide GLP-1RA
PIONEER TEENS 4
(NCTOA596631) Semaglutide GLP-1RA
NCTO4029480 Ertugliflozin SGLT2 inhibitor
NCTO3170518 Canagliflozin SGLT2 inhibitor
DINAMO Empagliflozin® SGLT2 inhibitor
(NCTO3429543) Linagliptin DPP-4 inhibitor
T2NOW Dapagliflozin SGLT2 inhibitor
(NCTO3199053) Saxagliptin DPP-4 inhibitor
* Empagliflozin was approved by the FDA in June 2023 for the treatment of children and adolescents with T2D.
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Copyright © 2010-2024, PeerVoice
Investigational Therapies for T2D in Young People
Trial Intervel n Arm Mechanism of Action
SURPAS-PEDS a 4
(NCTO5260021) Tirzepatide GLP-1RA
PIONEER TEENS 4
(NCTOA596631) Semaglutide GLP-1RA
NCTO4029480 Ertugliflozin SGLT2 inhibitor
NCTO3170518 Canagliflozin SGLT2 inhibitor
DINAMO Empagliflozin® SGLT2 inhibitor
(NCTO3429543) Linagliptin DPP-4 inhibitor
T2NOW Dapagliflozin SGLT2 inhibitor
(NCTO3199053) Saxagliptin DPP-4 inhibitor
* Empagliflozin was approved by the FDA in June 2023 for the treatment of children and adolescents with T2D.
www.peervoice.com/GBR870
Copyright © 2010-2024, PeerVoice
PeerVoice
DINAMO: Primary Outcome and AEs
For the primary outcome, the adjusted
mean HbAlc change from baseline at week
= 26 was -0.84% in the empagliflozin pooled
1 | — P80 (n= 53) group vs PBO (P = .012)
— Empagliflozin Pooled (n = 52)
+ Hypoglycaemia was the most
frequently reported AE, with
higher rates for those on active
eo drug treatment
+ No severe hypoglycaemia
cases were reported
Mean (SD) HbAlc, %
oa y 26 30 a2 82
Time, wk
www.peervoice.com/GBR870 Copyright © 2010-2024, PeerVoice
DINAMO: Primary Outcome and AEs
For the primary outcome, the adjusted
mean HbAlc change from baseline at week
= 26 was -0.84% in the empagliflozin pooled
1 | — P80 (n= 53) group vs PBO (P = .012)
— Empagliflozin Pooled (n = 52)
+ Hypoglycaemia was the most
frequently reported AE, with
higher rates for those on active
eo drug treatment
+ No severe hypoglycaemia
cases were reported
Mean (SD) HbAlc, %
oa y 26 30 a2 82
Time, wk
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E 5 Comorbidities
T2D in Children
and Adolescents
Mental health challenges
Adherence issues
www.peervoice.com/GBR870 Copyright © 2010-2024, PeerVoice
E 5 Comorbidities
T2D in Children
and Adolescents
Mental health challenges
Adherence issues
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PeerVoice
Abbreviations and References
Initial Management of T2D in Children and Adolescents
Abbreviation(s): HbAlc: glycated haemoglobin; HHS: hyperglycaemic hyperosmolar syndrome; T2D: type 2 diabetes.
Reference(s): Shah AS et al. Pediatr Diabetes. 2022;23:872-902.
Follow-Up Management of T2D in Children and Adolescents
Abbreviation(s): GLP-1 RA: glucagon-like peptide-1 receptor agonist.
Reference(s): Shah AS et al. Pediatr Diabetes. 2022;23:872-902.
Investigational Therapies for T2D in Young People
Abbreviation(s): DPP-4: dipeptidyl peptidase 4; FDA: US Food and Drug Administration; SGLT2: sodium-glucose
cotransporter 2.
Reference(s): Tamborlane W, Shehadeh N. Adv Ther. 2023;40:4711-4720.
FDA Press Release: FDA Approves New Class of Medicines to Treat Pediatric Type 2 Diabetes.
https://www fda gov/news-events/press-announcements/fda-approves-new-class-medicines-treat-pediatric-type-
2-diabetes. Accessed 26 March 2024.
www.peervoice.com/GBR870 Copyright © 2010-2024, PeerVoice
Abbreviations and References
Initial Management of T2D in Children and Adolescents
Abbreviation(s): HbAlc: glycated haemoglobin; HHS: hyperglycaemic hyperosmolar syndrome; T2D: type 2 diabetes.
Reference(s): Shah AS et al. Pediatr Diabetes. 2022;23:872-902.
Follow-Up Management of T2D in Children and Adolescents
Abbreviation(s): GLP-1 RA: glucagon-like peptide-1 receptor agonist.
Reference(s): Shah AS et al. Pediatr Diabetes. 2022;23:872-902.
Investigational Therapies for T2D in Young People
Abbreviation(s): DPP-4: dipeptidyl peptidase 4; FDA: US Food and Drug Administration; SGLT2: sodium-glucose
cotransporter 2.
Reference(s): Tamborlane W, Shehadeh N. Adv Ther. 2023;40:4711-4720.
FDA Press Release: FDA Approves New Class of Medicines to Treat Pediatric Type 2 Diabetes.
https://www fda gov/news-events/press-announcements/fda-approves-new-class-medicines-treat-pediatric-type-
2-diabetes. Accessed 26 March 2024.
www.peervoice.com/GBR870 Copyright © 2010-2024, PeerVoice
PeerVoice
Abbreviations and References (Cont'd)
DINAMO: Primary Outcome and AEs
Abbreviation(s): AE: adverse event; PBO: placebo.
Reference(s): Laffel LM et al. DINAMO Study Group. Lancet Diabetes Endocrinol. 2023;11:169-181.
T2D in Children and Adolescents: An Urgent Challenge
Reference(s): Courtesy of Maria Craig, MBBS, PhD, FRACP, MMed(ClinEpid); March 2024.
Nadeau KJ et al. Diabetes Care. 2016;39:1635-1642.
www.peervoice.com/GBR870 Copyright © 2010-2024, PeerVoice
Abbreviations and References (Cont'd)
DINAMO: Primary Outcome and AEs
Abbreviation(s): AE: adverse event; PBO: placebo.
Reference(s): Laffel LM et al. DINAMO Study Group. Lancet Diabetes Endocrinol. 2023;11:169-181.
T2D in Children and Adolescents: An Urgent Challenge
Reference(s): Courtesy of Maria Craig, MBBS, PhD, FRACP, MMed(ClinEpid); March 2024.
Nadeau KJ et al. Diabetes Care. 2016;39:1635-1642.
www.peervoice.com/GBR870 Copyright © 2010-2024, PeerVoice
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