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Case Presentation

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A 12 years-old-girl was referred to diabetes

clinic for diabetes check up as her recent fasting

blood sugar 127mg/dl. She has no past history

of Diabetes /IGT/IFG.

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On further enquiry:

*No symptoms of diabetes except slightly blurred

vision sometimes and excessive drinking of water for last 1month.

*Menarche in March 2010 and cycles are regular.

*Birth weight : 3.5 kilos and

*Normal mile stones, growth.

*No Growth Chart available.

*Normal School performance.

*Eats Junk food and eat less fruits.*No participation in sports

Family H/O: Father has Type 2 diabetes.

Mother: No h/o GDM/Thyroid disease.

Both parents were overweight.

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Examination:

*Height-155cm (90th centile)*Weight-79kg (>95th centile)

*BMI-32.5 (>95th centile)

*Waist circumference: 88.5cm (>90th centile

).*Acanthosis nigricans

*Blood pressure:116/78mmhg (>90th-

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Lab Work Up:

*HBA1c: 6.9% and*FBS: 102mg /dl (N

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Lab Work up conti

*Lipid profile: HDL: 31 mg/dl (>40mg)

TGl: 167mg/dl (< 150mg)

LDL:144mg/dl (

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Diagnosis:

Metabolic syndrome(Increased WC+ presence of 2 other Variables)

*Obesity & Waist Circum: >90th percentile.

*IFG and IGT

*Blood pressure: >90th-

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Treatment Plan

*Life style modifications: Healthy diet

*Increasing physical exercise

*Education and Counseling

*Pharmacological Therapy if indicated.

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Treatment..

Pharmacological therapy: Metformin was given.

Follow up: After 1month, she lost 3 kg and lab work uprevealed improved LFT , Increased HDL and decreased

FBS: 99mg/dl.

Continued her on same advice and same medications.

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Summary

This 12 years old girl diagnosed to have

metabolic syndrome: abdominal obesity, high

triglycerides, low levels of HDL-c, elevated fasting

plasma insulin, IFG & IGT and she showed

improvement in her metabolic parameters

following life-style interventions, behavioral

modifications and pharmacological therapy.

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Discussion points:

Differentiating from Type 1 diabetes and othercauses of Obesity (hormonal and genetic).

Screening for all components of Metabolic

syndrome: include Waist circumference .

Height, Weight, BMI/WC and Blood Pressure

Should be routinely measured during visits.

Early detection followed by treatment.

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Characteristics of Idiopathic and Endogenous Obesity

Idiopathic obesity Endogenous obesity>90 percent of cases 50th percentile) Short stature (usually

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Review of literature:

*The metabolic syndrome was first identified

by Reaven as Syndrome X(Duggan c et al 2008).

*The metabolic syndrome has been defined as aconstellation of major risk factors including

Abdominal Obesity, high triglycerides, low levels of

HDL-C, elevated fasting plasma insulin, IGT/IFG andhypertension (Misra A et al . 2007) 895-910.

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Review of Literature

*Increase in childhood overweight and obesity

= Prevalence of metabolic syndrome.NHANES III: 89% of Overweight: 1 abnormality

56% of Overweight: 2 abnormalities

* Increasing Prevalence of MS in developing countries:

-Maternal gestational diabetes,

-Low birth weight

-Infant feeding practices,-Genetic, socio-economic or environmental

-Urbanization, Unhealthy diet

-Sedentary lifestyles (IDF 2007).

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The recent IDF definition: Waist circumference as a mandatorycriterion and 2 or more cutoffs for other risk variables (Pergher RN et al,2010)

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Review of literature.Screening, Prevention and Treatment

*There is lack of consensus on the definition of themetabolic syndrome in children (Misra A et al 2007).

*Evaluation ofoverweight or obese children shouldinclude screening for metabolic risk factors(Duggan cet al 2008).

*75th percentile of Waist circumference can be usedas anactionpoint for Indian children to identify

obesity (Kuriyan R et al. Indian Pediatrics 2011 March 15).

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Review of literature Screening, Prevention and

Treatment ..

*Life style Interventions like dietary modifications and

regular exercise should be promoted (A. Misra et al. 2007)

*Metformin: Children with the metabolic syndromeand hyperglycemia`(Falkner et al. Pediatrics 2002)

*Pharmacological treatment of dyslipidemia: >10ys and the

LDL-C > 190 mg/dL (or >160 mg/dl with two additional riskfactors)(American Academy of Pediatrics, NCEP)

*Search for secondary causes of hypertension in

children before starting therapy (A. Misra et al. 2007)

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Thank you

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An HbA1c of 6.5% is recommended as the cutpoint for diagnosing diabetes.

The WHO Consultation concluded that HbA1ccan be used as a diagnostic test for diabetes,

provided that stringent quality assurance tests

are in place and assays are standardized tocriteria aligned to the international reference

values, and there are no conditions present

which preclude its accurate measurement