Approach to Diagnosing a Pediatric Patient with Severe Insulin Resistance in Low-or Middle-income Countries

Alise A. Van Heerwaarde, Renz C.W. Klomberg, Conny M.A. Van Ravenswaaij-Arts, Hans Kristian Ploos Van Amstel, Aartie Toekoen, Fariza Jessurun, Abhimanyu Garg, Daniëlle C.M. Van Der Kaay

Research output: Contribution to journalArticlepeer-review

Abstract

Diabetes mellitus (DM) in children is most often caused by impaired insulin secretion (type 1 DM). In some children, the underlying mechanism for DM is increased insulin resistance, which can have different underlying causes. While the majority of these children require insulin dosages less than 2.0 U/kg/day to achieve normoglycemia, higher insulin requirements indicate severe insulin resistance. Considering the therapeutic challenges in patients with severe insulin resistance, early diagnosis of the underlying cause is essential in order to consider targeted therapies and to prevent diabetic complications. Although rare, several disorders can attribute to severe insulin resistance in pediatric patients. Most of these disorders are diagnosed through advanced diagnostic tests, which are not commonly available in low-or middle-income countries. Based on a case of DM with severe insulin resistance in a Surinamese adolescent who was later confirmed to have autosomal recessive congenital generalized lipodystrophy, type 1 (Berardinelli-Seip syndrome), we provide a systematic approach to the differential diagnosis and work-up. We show that a thorough review of medical history and physical examination generally provide sufficient information to diagnose a child with insulin-resistant DM correctly, and, therefore, our approach is especially applicable to low-or middle-income countries.

Original languageEnglish (US)
Pages (from-to)3621-3633
Number of pages13
JournalJournal of Clinical Endocrinology and Metabolism
Volume106
Issue number12
DOIs
StatePublished - Dec 1 2021

Keywords

  • Berardinelli-Seip syndrome
  • Diabetes mellitus
  • children
  • insulin resistance
  • lipodystrophy
  • low-or middle-income country

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Biochemistry
  • Endocrinology
  • Clinical Biochemistry
  • Biochemistry, medical

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