Type 2 Diabetes Mellitus with Diabetic Ketoacidosis, Hypertriglyceridemia, and Acute Pancreatitis in an Adolescent with Autism Spectrum Disorder and Pancreatic Divisum.

Children with developmental disorders such as autism spectrum disorder (ASD) may not only develop type 2 diabetes mellitus (T2DM) due to psychosocial stress and overeating but also experience severe complications such as acute pancreatitis (AP) and hypertriglyceridemia (HTG). Consequently, in pediatric patients with concurrent T2DM and developmental disorders, a comprehensive approach is necessary that includes not only imaging evaluations for AP but also assessments of risk factors such as psychological stress and metabolic abnormalities. We report the case of a 13-year-old male child, with a family history of T2DM in his paternal grandfather, who presented with severe diabetic ketoacidosis (DKA) and HTG (triglycerides 2118 mg/dL). His condition was considered to have been triggered by psychosocial stress following the divorce of his parents two months previously, which led to episodes of overeating. Two weeks prior to admission, he had consumed excessive amounts of soft drinks. The patient was initially treated with fluids, insulin, and mannitol for cerebral edema. On the third day post admission, he developed AP, which was confirmed by the occurrence of abdominal pain, elevated pancreatic enzyme levels, and the findings of CT imaging. Subsequent imaging revealed pancreatic divisum. The patient was also diagnosed with ASD during hospitalization. Following a temporary initial recovery, the patient experienced worsening obesity and was started on metformin and icosapent ethyl to manage recurrent T2DM and HTG. In this case, the development of T2DM was considered to have been primarily associated with ASD, which subsequently led to DKA, HTG, and AP, with pancreatic divisum believed to be an additional predisposing factor contributing to these conditions. To the best of our knowledge, there have been no previous reports of T2DM associated with DKA, HTG, AP, ASD, and pancreatic divisum.