International Journal of Science and Research (IJSR) ISSN: 2319-7064 ResearchGate Impact Factor (2018): 0.28 | SJIF (2019): 7.583 Volume 9 Issue 7, July 2020 www.ijsr.net Licensed Under Creative Commons Attribution CC BY A Report of Two Cases Type 2 Diabetes Mellitus in Children Vania Catleya Estina 1 , I Wayan Bikin Suryawan 2 , I Made Arimbawa 3 1, 2, 3 Udayana University, Medical Faculty, Department of Child Health, Sanglah Hospital, Denpasar, Indonesia Abstract: Background : Type-2 diabetes mellitus (T2DM) was initially considered an adult entity. The case has now been reported in children in developed countries because of the increased incidence of obesity and sedentary habits associated with lifestyle changes. T2DM was diagnosed based on the absence of ketosis, good beta-cell reserve, as shown by the C-peptide assay, the absence of insulin autoantibody, and response to oral hypoglycemic agents. Objective : These case reports aim to describe clinical characteristics, management, and social aspects of T2DM in children. Case : The first case, a 12-year old female with a familial history of T2DM, presented with a history of weight loss for the past year. She also experienced vulvovaginal candidiasis. Her initial laboratory results upon admission were 14.5% HbA1C and 1.3 ng/mL C-peptide. The second case was an obese, 10- year old female who presented with frequent urination for the past six months. Her mother experienced gestational diabetes in the past. Her laboratory results upon admission were 10.7% HbA1C and 2.4 ng/mL C-peptide. Both cases were managed well by long-acting insulin and oral metformin. Systematic screening and evaluation management of T2DM is essential for clinicians. These include additional focus on lifestyle management and familial support. For patients with obesity, efforts targeting weight loss, including lifestyle modification and medication, are recommended to prevent complications. Keywords: type 2 diabetes mellitus, children, obese 1. Introduction Type-2 diabetes mellitus (T2DM) was rarely reported in children, accounting for <2% of all cases of diabetes in pediatric. However, a recent increase in its incidence in children and adolescents has been documented in several populations paralleling the increase in prevalence and degree of obesity in children and adolescents [1]. Over the past three decades, the prevalence of childhood obesity has increased dramatically in Indonesia, ushering in a variety of health problems, including T2DM, which previously was not typically seen until much later in life. Currently, in Indonesia, up to 1 in 3 new cases of diabetes mellitus diagnosed in youth younger than 18 years is T2DM, with a disproportionate representation in ethnic minorities and occurring most commonly among youth between 10 and 19 years of age. There was an increasing number of children with T2DM in Indonesia (based on the Indonesia National Registry). Incidence of Indonesia children with T2DM less than T1DM. Almost all data are from Jakarta as the capital city [2], [3]. Along with the increased prevalence of obesity in children and adolescents, there is also an increase in the prevalence of various complications of obesity, including T2DM in children and adolescents. It should be a larger number of cases because of the increasing number of obese children. Obese and diabetes family history are the risk factors for Indonesia children with T2DM. The onset of T2DM in children and adolescents is most common in the second decade of life with a median age of 13.5 years and is rare before the age of puberty. T2DM in children and adolescents usually come from families with a history of T2DM [4], [5]. These case reports aim to describe clinical characteristics, management, and social aspects of T2DM in children. 2. Case Reports First case, a 12-year old female was referred from a general hospital with suspicion of T1DM. Her mother reported she has been losing weight since a year ago. Her body weight was 65 kg and now is 50 kg, despite having a good appetite. She has been consuming much water since three months ago after she experienced frequent urination since three months ago. She also complained about itchy, white-discharge from the vagina a week before admitted to our hospital. She reported no fatigue, prolonged wound healing, coughing, or flu symptoms. Bowel habit was normal. During admission at another hospital a year ago, her blood tests came back and showed an increased blood sugar level (376 mg/dL) with ketone +2 and glucose +2 in urine examination. Her family history that father was diagnosed with T2DM 5 years ago. Upon presentation, she was feeling weak, with no nausea or vomiting. She appeared moderately ill and alert, pulse rate was 88 beats per minute, regular with good pulse quality, respiratory rate was 24 times per minute, regular, the axillary temperature was 36.8 °C, and reported no pain. Her body weight was 47.5 kg with 154 cm height with nutritional status was well-nourished. Laboratory findings showed increased blood glucose (292 mg/dL) and elevated HbA1c (14.5%). We prescribed subcutaneous long-acting insulin (Lantus®) dose 0-0-15 IU and oral metformin 500 mg every 12 hours. She was scheduled then to check regular blood glucose, C-peptide level, and lipid profile. Management for this patient includes medications, nutrition support, monitoring plan, as well as patient and family education toward the disease and its long-term prognosis. We also sent her to a venereologist to be evaluated. Assessment of the quality of life of children and possible behavioral disturbances was conducted with the PedsQL Paper ID: SR20704205111 DOI: 10.21275/SR20704205111 514