6724 Children and young people presenting in diabetic ketoacidosis(DKA) on first presentation of Type 2 Diabetes Mellitus(T2DM) in a District General Hospital(DGH)

Objectives To analyze clinical characteristics of children and young people (CYP) with T2DM presenting with DKA over a 3-year period in a DGH. Comparison of clinical characteristics of this group with clinical features at diagnosis of other CYP with T2DM not presenting in DKA in the same period. Laboratory and treatment data also examined. Methods Review of all CYP presenting with T2DM in terms of demographics, presenting symptoms, clinical features, family history, pancreatic antibody, insulin/c peptide levels, SARS Covid antibody and treatment from January 2020- December 2022. Results 4 out of 10 CYP with newly diagnosed T2DM presented in DKA. One of the 4 young people had a hyperosmolar state in association with DKA. Ages ranged between 10.6–15.9 years with equal number of boys and girls. Three of the CYP had BMI classed as morbidly obese, two were severely obese, three obese and one overweight(RCPCH BMI chart). One CYP did not have height measured, however her weight was >99.6th centile. Ethnicity: 6 CYP were Black African/Afro-Caribbean of whom 4 were in DKA; 3 South Asian and 1 White Irish. Acanthosis nigricans was noted in 5(50%). Positive family history of T2DM in 9 (90%) of the CYP of whom 8 had at least one parent affected. All CYP had negative pancreatic autoantibodies(100%). Insulin/C peptide was raised in 5 of the CYP and normal in 1 of the CYP not presenting in DKA. Insulin level was low in one CYP presenting in DKA and normal in another. Data on Insulin/C peptide was not available in the remaining two. Treatment: Metformin alone in 3 CYP at diagnosis; remainder treated with insulin initially with metformin/liraglutide later. HBA1C improved in 9 CYP; One did not have a baseline HBA1C. SARS Covid antibody: 8 negative, 2 not tested. Conclusion Considering risk factors such as family history of T2DM and BMI may be helpful for clinicians to suspect T2DM in CYP with DKA. CYP presenting in DKA and not in DKA were very similar in our study. DKA management in T2DM should be the same as for Type 1 diabetes but hyperosmolar state needs special precautions. Recent articles indicate DKA in T2DM is being increasingly recognized at presentation.1 2 We did not find any Covid positive children in our cohort but an increased incidence of DKA in new- onset T2DM in CYP has been reported during the Covid-19 pandemic.3 References Loh et al. Diabetic ketoacidosis in paediatric patients with type1-and type 2 diabetes during the COVID-19 pandemic. Metabolism 2021 Sep;122:154842.doi:10.1016/j.metabol.2021.154842. Epub 2021 Jul 30. Haliloglu et al. The distribution of different types of diabetes in childhood: a single center experience. J Clin Res Pediatr Endocrinol 2018;10(2):125–130. Chao et al. Spike in Diabetic Ketoacidosis rates in paediatric Type 2 diabetes during the COVID-19 pandemic. Diabetes Care 2021 Jun;44(6):1451–1453 doi:10.2337/dc20-2733. Epub 2021 Apr 26.