P-508: Type 2 diabetes in adolescents with obesity in a high-risk European region: heterogeneous clinical presentation and early therapeutic outcomes

Introduction

The incidence of type 2 diabetes mellitus (T2DM) in pediatric population is increasing worldwide. The Azores have a high prevalence of childhood obesity, reinforcing the need for metabolic surveillance due to increased risk of T2DM.

Objectives

To describe heterogeneity of clinical presentation and progression of T2DM in adolescents, highlighting the importance of early diagnosis and multidisciplinary management.

Methods

Retrospective analysis of three cases of adolescents with T2DM, from the Azores, followed at a pediatric endocrinology outpatient clinic. Anthropometric data, clinical presentation, HbA1c values, diabetes-related autoimmunity and treatment response were analyzed.

Results

Case 1: A 16-year-old male with obesity (BMI 38,9kg/m2) presented with diabetic ketoacidosis - HbA1c 11.9%, C-peptide 5.65ng/mL (ref. 1.4-4.4) and negative autoimmunity. After 9 months, insulin was discontinued following 11.5% weight loss, achieved with lifestyle and pharmacological interventions. Current HbA1c is 5.2% under metformin 1mg/day and semaglutide 1mg/week, without micro or macrovascular complications.

Case 2: A 13-year-old female with obesity (BMI 27.8kg/m2) was diagnosed on routine testing (HbA1c 6.7%). Lifestyle interventions and metformin 1.7g/day were started, but she discontinued follow-up. Three years later, she presented with decompensated T2DM (HbA1c 8.8%), requiring basal insulin therapy (14 units). After 5 months, HbA1c is 7.7% under basal insulin (10 units), metformin 1.7g/day and semaglutide 0.5mg/week, without weight loss.

Case 3: A 10-year-old male with obesity (BMI 30.2kg/m2) was diagnosed on routine testing (HbA1c 7.1%). Despite irregular adherence to metformin (max. prescribed dose 1.7g/day) and no weight loss, HbA1c remains <6.5%.

Conclusions

This case series highlights the clinical heterogeneity of pediatric T2DM and its strong association with obesity. It reinforces the need for obesity prevention public health policies and systematic T2DM screening to prevent long-term complications.