Endocrine Abstracts

Introduction: We hypothesised that children with type 1 diabetes would have more hyperglycaemia following a British as compared to a European breakfast.Methods: Children were asked to take a continental breakfast and a typical British breakfast cereal on separate days. Pre breakfast glucometer readings were documented and then regular readings until lunchtime. The meals were prescribed by a dietitian; they were approximately carbohydrate matched but of d...

Background: HbA1c remains the most powerful outcome measure for children and young people with diabetes. It is collected at every clinic visit and is used for individualised discussions around diabetes control and for national benchmarking. However, despite DCCT and IFCC standardisation, there is still no overall consensus as to the most appropriate methodology, particularly when assessing patients with haemoglobinopathies that may affect HbA1c measurement.<p class="abstex...

Screening for complications and associated conditions in children with type 1 diabetes is routinely performed in Diabetes Clinics. Though there are NICE recommendations screening tests, interpretation and management is varied as there is no strong evidence base in paediatrics. We conducted a survey across diabetes units to establish the prevailing practice.Method: Survey monkey questionnaire was sent out to clinicians who care for children with diabetes ...

Introduction: Co-production refers to working in partnership with service-users to improve provision of services. Increasing evidence highlights that co-production can improve health care and result in financial savings. Service-users are involved in defining the problem or need, creating the solution, delivering it, and evaluating it. This approach demands longer-term engagement by service-providers but leads to sustainable change. Graphic facilitation is the use of large-sca...

Introduction: Total daily insulin required to achieve glycaemic control in type 1 diabetes (T1D) depends on numerous factors. Correlation of insulin requirement to BMI and waist circumference has been variably reported in the literature, whilst that of WHtR has not been studied.Aims: To study the correlation between daily insulin requirement (TDD) and WHtR in a multi-ethnic population.Methods: A cross-sectional study of children (5...

Background: Structured education should be appropriate to the learning styles of participants. Health professionals and experts in education worked together to develop KICk-OFF for 11–16 year olds and similar experience has now been used in the development of Junior KICk-OFF for Key Stage (KS) 1 (4–7 years) and KS2 (7–11 years).Method: The KICk-OFF team developed the curricula with input from teachers and an academic educationalist. Sectio...

Background: Animal studies have demonstrated relationships between Vitamin D and glucose homeostasis. There is paucity of evidence examining the relationship between the glycemic control in children with Type 1 Diabetes Mellitus (T1DM) and vitamin D status.Objective: To determine the effects of vitamin D status on the glycemic control in children and adolescents with T1DM.Methods: Retrospective data were collected on 348 children a...

Background: National paediatric diabetes audit (NPDA) provides comparative data for local paediatric diabetes units (PDUs) on key care processes and overall HbA1c. More detailed analysis on other variables affecting HbA1c is undertaken at a national level, but not at an individual PDU level.Objective: To determine the factors influencing glycaemic control (HbA1c levels) in young children and adolescents with Type 1 Diabetes Mellitus (T1DM).<p class="...

Background: In 2013 the Diabetes Team at a large children’s hospital commenced ‘Pump School’ for all children and young people (CYP) transitioning from multiple daily injections to insulin pump therapy (CSII) using Medtronic, Accu-chek, Animas and Omnipod pumps.Aim: To provide CYP and their parents/carers with structured education to improve their outcomes including glycaemic control, hypoglycaemic episodes and quality of life (QOL).<p...

Aim: To compare the BMI z-score of children with type 1 diabetes (T1DM) in Nottingham with that of national and local background populations and to identify factors associated with increased BMI.Methods: A retrospective observational cohort study of patients with T1DM aged 2–15 years under the care of the paediatric diabetes team at Nottingham Children’s Hospital, between April 2013 and March 2014. Mean BMI-z-score for the year was com...

Introduction: Type 1 diabetes (T1D) represents 5.3% of all types on diabetes. Its incidence is increasing around the world as it is in the Middle East and North Africa Region, where the incidence is at 1/100 000. T1D touches young subjects and is then established in a growing body. Transitional period is a crucial phase with physical and emotional distress. In Moroccan context, psychosocial difficulties are an additional challenge for these young patients.<p class="abstext...

Background: Animal studies have demonstrated relationship between Vitamin D and glucose homeostasis. There is paucity of evidence examining the relationship between the glycemic control in children with type 1 diabetes mellitus (T1DM) and vitamin D status.Objective: To determine the effects of vitamin D status on the glycemic control in children and adolescents with T1DM.Methods: Retrospective data were collected on 348 children an...

Background: Heterozygous loss of function glucokinase mutations causes MODY with fasting hyperglycaemia (>5.5 mmol/l). We report a 2 year girl with a glucokinase mutation who presented unusually with stress induced hyperglycaemia and normal fasting blood glucose levels.Case report: She presented with wheeze and was started on Salbutamol. Her blood glucose rose to 16 mmol/l with ketonuria. The hyperglycaemia was disproportionate to the severity of the...

Objectives: Many paediatric diabetes units in the UK have introduced 24 h telephone support to encourage self-management to reduce Emergency Department (ED) attendances and admissions. The UK national audit collects information on acute paediatric diabetic admissions; but there is no data available on ED attendances in this group. We undertook a retrospective audit of ED attendances as part of a baseline service evaluation of our newly introduced 24 h support service.<p cl...

Objectives: Best practice tariff guidelines recommend that paediatric patients with diabetes should have a minimum of four MDT clinic appointments, and an additional eight contacts with the diabetes service per year. This audit compares performance in a DGH against these recommendations. It seeks to determine whether there is a correlation between amount of contact with the service and average HbA1c level.Methods: Analysis of a database recording contact...

Background: Transition can be a difficult time for adolescents with chronic diseases leading to poor attendance in adult clinics and poor long-term health outcomes. The implementation of transition programmes like ‘ReadySteadyGo’ at University Hospital Southampton (UHS) aim to improve transitional care and outcomes for patients.Aims: To assess the effect of a structured transition programme, ‘Go’ from ‘ReadySteadyGo’, at UHS...

Self-monitoring of blood glucose (SMBG) is an important part of diabetes management. Continuous glucose monitoring (CGM) provides real-time measurement of users’ glucose levels. The advantage of CGM is the availability of constant information about glucose levels which helps to predict hyper and hypoglycaemia and to adjust the insulin doses accordingly. NICE guidelines recommend that children and young people with type 1 diabetes and persistent problems with hypoglycaemia...

Introduction: The impact of ethnicity and socioeconomic status (SES) on glycaemic control in children with type 1 diabetes (T1D) is poorly understood in England and Wales.Methods: We studied 18 478 children and young people with T1D aged <19 years attending diabetes clinics in England and Wales and included in the 2012–2013 National Paediatric Diabetes Audit (NPDA). Self-identified ethnicity was categorized as white, Asian, black, mixed, other a...

Case report: A 9-year-old girl of mixed ethnic origin presented with symptomatic hypercalcaemia with a 3-month history of weight loss and lethargy. Autoimmune hypothyroidism had been diagnosed 10 months previously. Serum vitamin D concentration (11 nmol/l) was low and cholecalciferol 20 000 units daily for 7 days followed by 800 units daily was commenced. One month later, her symptoms worsened and she had developed anaemia and renal impairment. Hypercalcaemia was noted (Corr C...

Introduction: Insulin requirements change with age, in part related to changes in Growth Hormone secretion. Little is known of the impact of age on the circadian variation in insulin secretion. We have studied changes in insulin basal rates as a proxy for insulin sensitivity in CYP with well controlled T1DM.Methods: Insulin pump settings for total daily dose (TDD) and sensitivity ratio were obtained from 22 CYP with T1DM. Basal insulin requirements were ...

Introduction: Poor HbA1c in the first year following diagnosis of type 1 diabetes is a predictor of poor metabolic control and early development of complications. Achieving good glycaemic control requires compliant, well-educated patients. In October 2013, we introduced a revised and extended ‘Newly Diagnosed Patient Education Programme’ in which a total of 20 sessions are delivered by the multidisciplinary team.Aim: To assess the effect of the...

Background: Current NICE guidance states that insulin pump therapy (CSII) can be considered in Type 1 diabetes (T1DM) patients who suffer disabling hypoglycaemia in an attempt to reach glycaemic control or whose HbA1C remains high (>69 mmol/l) despite careful management on multiple daily injections (MDI).Aims: Our aims were to determine impact of CSII therapy on glycaemic control, BMI, incidence of severe hypoglycaemia and episodes of diabetic ketoac...

Background: Previous studies have reported that increased BMI and increase in insulin requirement are associated with more rapid disease progression following diagnosis in type 1 diabetes mellitus (T1DM). The recent UK National Paediatric Diabetes Audit (NPDA) 2013/14 reported that 37% of 0–11 year old children and 44% of 12 years and older children are currently overweight or obese.Objective: Our objective was to evaluate factors associated with in...

Diabetic ketoacidosis (DKA) is a common medical emergency in children. Altered consciousness in the form of mild disorientation or confusion can occur but frank coma is uncommon.1 We present a case of a newly diagnosed Type 1 diabetes mellitus who presented in DKA and with glasgow coma scale (GCS) of seven. She developed decorticate posturing soon after she was commenced on resuscitation fluids.Case: A previously well 15-year-old girl was rush...

Background: Continuous glucose monitoring (CGM) measures interstitial glucose and display trends arrows, showing the direction and rate of change in glucose. Trend arrows allow the child/youth to take action to prevent hypo- and hyperglycaemia. Effective strategies for adjusting insulin boluses for trend arrows are lacking. The JDRF CGM Study Group recommended a 10/20% increase/decrease in the insulin dose. However this formula requires a mathematical calculation with each tre...

Background: Diabetic ketoacidosis (DKA) is a common presentation of newly diagnosed type 1 diabetes (T1DM) in children but increases the disease burden at diagnosis. In UK, average frequency of DKA presentation is reported as 25% with an international variation of 16 to 67%. Data on frequency variations within the UK is limited.Aim: To compare the demographic and clinical characteristics of DKA vs non-DKA presentations in children <16 years at diagno...

Background: Insulin dose requirements are higher during puberty and in overweight/obese individuals with type 1 diabetes mellitus (T1DM) due to insulin resistance. Through meta-analysis metformin has been shown to be beneficial as adjunctive therapy in T1DM adults independent of BMI. The large volumes of insulin required to administer higher insulin doses in insulin-resistant individuals have adverse effects on insulin absorption. Insulin degludec (Tresiba) U200 preparation al...

Introduction: HbA1c levels are used as objective long-term measure of glycaemic control in patients with type 1 diabetes mellitus (T1DM). Regular HbA1c measurement helps us to formulate the management and education to the patients and carers. But, in rare cases, it might not prove reliable, as in our case report.Case report: A 4 years old girl with known T1DM and autoimmune hyperthyroidism, had mitral valve repair for mitral valve regurgitation. She was ...

AbstractContinuous subcutaneous insulin infusion (insulin pump therapy) is recommended as a treatment option for patients with type 1 diabetes where multiple-dose insulin therapy has failed. These patients are looked after by a specialist multi-disciplinary team and those receiving this treatment should have the commitment and competence to use the pump effectively.We carried out a retrospective study on 33 paediat...

Iron is a transition metal that acts as an oxidant. There is evidence that systemic iron overload could contribute to abnormal glucose metabolism. Further research has showed that iron overload can result in an increased in type 2 diabetes irrespective of the cause of gene involved. Although the exact mechanism of iron-induced diabetes is uncertain, it is likely mediated by these three mechanisms: i) insulin deficiency, ii) insulin resistance, and iii) hepatic dysfunction....

Neonatal diabetes mellitus (NDM) is a rare form of monogenic diabetes affecting 1 in 100 000 to 500 000 live births.We report the case of a term baby born to a diet controlled gestational diabetic mother with a birth weight of 2.8 kg. Baby was persistently hyperglycaemic from day 1 of life, leading to a diagnosis of neonatal diabetes being considered. She was breast-fed on demand and although insulin pump therapy was discussed, it was felt not to be suit...

Background: Cystic fibrosis related diabetes (CFRD) is associated with deterioration in clinical status. Lung function and nutritional status deteriorate up to 2–4 years before a diagnosis of CFRD based on the oral glucose tolerance test (OGTT). Timely detection and treatment is crucial.Aims: To evaluate: i) adherence to CFRD screening guidelines and ii) whether identifying stages of progressive cystic fibrosis insulin deficiency (CFID) using the ex...

Background: Continuous subcutaneous insulin infusion (CSII) therapy is increasingly used for managing children with type 1 diabetes mellitus. Devices vary in design by manufacturer; however in general terms insulin is administered from the pump via a subcutaneous plastic catheter or needle. If the pump or the circuit malfunction and interrupt the insulin infusion, it can put the patient at risk of hyperglycaemia.Case: A 5-year-old boy with type 1 diabete...

Background: Diabetic ketoacidosis (DKA) in children and young adults carries significant morbidity and mortality relating to complications such as cerebral oedema. Acute kidney injury (AKI) is a rare but potentially fatal complication of DKA. We present three cases of DKA complicated by AKI.Case 1: A 9-year-old girl presented with severe DKA at diagnosis. She was treated with intravenous fluids and insulin as per protocol. She had oliguria and haematuria...

Background: Type 1 diabetes (T1D) is characterised by autoimmune destruction of pancreatic beta cells leading to insulin deficiency. Prompt referral and treatment is important to prevent diabetic ketoacidosis (DKA) which remains the commonest cause of death in this condition. NICE guidance 2004, advises same day referral to specialist paediatric Diabetes team when childhood diabetes is suspected.Aim: The aim was to audit the timeliness of referrals of ch...

Introduction: 25 314 children and young people <18 years with diabetes in England and Wales have been looked after in 178 paediatric diabetic units (PDUs) across the country. In 2012–2013, BPT has been introduced with 13 mandatory requested criteria, one of them is; each patient should have an annual assessment as to whether input to their care by a clinical psychology input is needed, and access to psychological support as appropriate. Therefore we aimed to study the...

Cystic fibrosis related diabetes (CFRD) is the commonest co-morbidity in CF leading to increased mortality rates. The pathophysiology includes pancreatic fibrosis, reduction in α and ß-cell mass, delayed insulin secretion and variable insulin insensitivity. Insulin production can fluctuate with progression over time to an insulinopenic state. We report two cases of young people with CFRD with high insulin requirements, poor glycaemic control and improvement with the ...

Forum for injection technique (FIT) recommendations for lipohypertrophy (LH) detection influenced clinical examination technique with the aim of improving practice and health outcomes for children and young people (CYP). Interactive LH workshops were developed to influence a change in care provision and facilitate swift integration into clinical practice.The event was delivered to MDT representatives from the CYP diabetes network. A structured clinical e...

Background: Insulin pumps are used in the management of type 1 diabetes in children at Macclesfield District General Hospital (MDGH). There has been no study previously conducted at MDGH to check the efficacy of the insulin pumps against non-pump methods such as multiple daily injections.Methods: Review on the number of admissions, type of admissions and insulin administration method were collected from the years 2012–2015. The types of admissions w...

With the increase in incidence of type 1 diabetes in children and young people (CYP) and the use of intensive insulin therapies, paediatric diabetes teams are under increasing pressure to support school staff with the day to day management of their pupils with diabetes. The CYPWMDN have developed a study day to provide basic diabetes awareness education to all school staff in the West Midlands (WM) region. This work also meets the training and support responsibilities of diabe...

Background: Hypoglycaemia is a common complication of diabetes which causes great anxiety in patients and their families. Asymptomatic hypoglycaemia can be debilitating, especially in young children. All patients who attend Children and Young People (CYP) Diabetes Clinic have their blood glucose tested. If hypoglycaemia is identified (Blood Glucose less than 4 mmol/l), the local hypoglycaemia hospital policy should be followed by staff to provide safe and effective treatment.<...

In 2010 non-communicable diseases were shown to be the most important cause of mortality worldwide on the WHO global status report, with diabetes the 4th most common disease causing death. Type 1 diabetes Mellitus (T1DM) is the most common form of diabetes in children and young people. There is a paucity of data regarding T1DM in children in West Africa, in particular in The Gambia.Aim: To explore the clinical presentation and outcome of children with T1...

Introduction: The National Paediatric Diabetes Audit (NPDA) in 2012 reported a twofold increase in the incidence of diabetes ketoacidosis (DKA) admissions from 2005/6 to 2010/11 in children and young people with type 1 diabetes mellitus (T1DM). The paediatric diabetes best practice tariff (BPT) was introduced in 2012 to incentivise provision of high quality care to those under the age of 19.Aims: We examined DKA admission rates in children and young adul...

Introduction: Chromosome 9p trisomy is a rare chromosomal syndrome in which a portion of the 9th chromosome appears three times rather than twice in cells of the body. Most often these children present with developmental delay, craniofacial malformation and growth deficiency. We present a case of insulin dependent diabetes in a 5-year-old boy known to have a diagnosis of Chromosome 9p trisomy.Case: Born at 38+3, by normal vaginal delivery with birth weig...

Brief overview: The control of diabetes is a somewhat constant chase, with optimal control being the goal. Indeed, there are many methods marketed claiming to improve control. This is with neglect to the most basic of techniques, blood glucose monitoring. This is highly dependent on individual and parent motivation levels.Objective: The objective of this study is to answer the question, ‘Does the frequency of blood glucose monitoring affect the cont...

Background: Diabetic ketoacidosis (DKA) is associated with significant morbidity and mortality. Comparison of healthcare systems often helps highlight areas of concern.Design: In a short survey, we evaluated severity of DKA at presentation with diabetes by comparing clinical and biochemical data from clinic cohorts from paediatric diabetes units in Delhi, India and Manchester, UK.Results: In the Delhi vs UK groups; there were no si...

Introduction: Non-adherence to treatment is common in teenagers with type 1 diabetes (DM1). We aim to report on our experience, in a University teaching hospital, on factors leading to non-adherence, and describe strategies which improve compliance.Discussion: There are numerous factors which account for why teenagers fail to adhere to treatment.i) Lack of knowledge about the condition.ii) Teenagers may not u...