Endocrine Abstracts

Introduction: Type 1 diabetes mellitus is one of the most common chronic diseases in children. Precise knowledge of the pathogenesis of diabetes mellitus type 1 and its chronic complications is the enormous challenge in modern diabetology. In recent years, the role of leptin in the pathogenesis of microvascular diabetic complications has been highlighted.Aim: The aim of the study was to investigate serum leptin level and correlations between leptin level...

Background: Recent NPDA 15/16 data shows that nationally 17.9% of children and young people (CYP) with type 1 diabetes mellitus (T1DM) have a HbA1c level >80 mol/mol (7.9% at Nottingham Children’s Hospital (NCH)), putting them at increased risk of diabetic ketoacidosis and long-term sequelae. To support patients on the high HbA1c pathway (>80 mmol/mol) at NCH, a 5-day inpatient stay for stabilisation is offered. The process involves daily re-education from paediat...

Introduction and objective: Early glycaemic control is predictive of long-term control. Children who present with diabetic ketoacidosis (DKA) at the time of type 1 diabetes diagnosis are at risk for poorer long-term glycaemic control. Intensive education and support with multidisciplinary team (MDT) input is vital to overcoming these outcomes. In this retrospective analysis, we compared 6 month-HbA1C outcomes in children with and without DKA at diagnosis.<p class="abstext"...

Introduction: The hyperinsulinism/hyperammonemia (HI/HA) syndrome is the second most common cause of hyperinsulinemic hypoglycaemia (HH), caused by activating mutations in GLUD1 [which encodes the mitochondrial enzyme glutamate dehydrogenase (GDH)].Methods: We describe phenotypic variations in three patients from 3 non-related families with HI/HA syndrome due to GLUD1 mutation.Results: Patient 1, a 10-year-old Cau...

Background: To assess whether the improved service provision introduced under the new Paediatric Diabetes Best Practice Tariff, which includes increased contact with the multi-disciplinary team and greater access to psychology support, has impacted positively on the quality of life (QoL) and glycaemic control of young people with diabetes.Method: In 2011, n=55 children and young people with diabetes completed the Generic Paediatric Quality of Li...

Introduction: In August 2015, the British Society for Paediatric Endocrinology and Diabetes (BSPED) released new guidelines for the management of DKA. These new guidelines recommended a much more conservative approach with fluid management in order to reduce the risk of cerebral oedema.Aim: Based on local anecdotal evidence, we hypothesized that with the new guidelines, we have had to increase maintenance fluid infusion rates more often and that the chil...

Introduction: ABCC8 gene mutations cause transient and permanent forms of neonatal diabetes with variable modes of inheritance. Almost all patients present with diabetes under 6 months old with rare cases upto 12 months. We report 2 siblings with diabetes and identical homozygous mutations of the ABCC8 gene, one of whom presented classically under 6 months old and the other unusually at 3 years of age.Cases: The index case, a British Pakistani f...

Aim: Previous studies have shown that diabetes associated antibodies are present in 85–90% of patients with Type 1 diabetes. NICE guidelines do not suggest routine use of antibodies screening at initial presentation. The aim of our study was to identify the incidence of antibody positivity in our centre and also review the clinical profile of children diagnosed with diabetes who were antibodies negative.Method: Retrospective case notes review of 243...

Background: NICE recommendation is to use multiple daily insulin injections and to offer level 3 carbohydrate-counting education at diagnosis of Type 1 diabetes (T1DM), and at least at annual intervals thereafter. Best Practice Tariff states that every young person with diabetes should be offered at least one additional appointment per year with a paediatric dietitian with training in diabetes. Our aim was to identify details of all the patients in the current cohort who were ...

Introduction: Bolus calculator glucose meters (BCGM) facilitate self-management of patients with type 1 diabetes (T1DM). However, their effectiveness is dependent on the accuracy of the data entered, use of their smart functions and adherence to the insulin dosages advised. This study investigates whether optimising the use of BCGM is associated with better glycaemic control in children and adolescents with T1DM, and obstacles to preventing their effective use.<p class="ab...

Introduction: For the last 2 years we have been giving regular diabetes education sessions in conjunction with our hospital school, based around maths skills. These went well, but we wanted to develop these further, making them more patient centred. We gained a grant from the Diabetes Research and Wellness Foundation and designed a 4 day programme with ‘The Puppet Project’ and ‘WAC arts’. This was done very much in collabaration with our hospital school who...

Introduction: The current estimate of prevalence of type I diabetes in children under 15 years in England and Wales is 187.7 per 100,000, with an estimated 31,500 children with diabetes under 19 years. It is a condition that is becoming increasingly common with 28.2 per 100,000 new diagnoses each year. Increasingly, management of these children is led by children and young people diabetes(CYPD) multi-disciplinary teams(MDT). As a result, despite better outcomes in diabetes car...

Introduction: Research has shown that Type 2 diabetes can be reversed in early stages if diet control is exercised. We present herewith a case of a 13-year old girl with Type 2 diabetes with a background of brain tumour, epilepsy and learning difficulties. Due to wider psychosocial issues the patient was placed in foster care. Adherence to healthy lifestyle principles led to weight loss and subsequent resolution of the Diabetes.Case report: A 5-year-old ...

Introduction: A systematic review and meta-analysis undertaken by Bell et al, 2013 found limited evidence to recommend carbohydrate counting as the standard dietary therapy in Type 1 Diabetes (T1DM). There seems to be a gap in current knowledge about comparing carbohydrate counting with other meal planning approaches for children and young people (CYP) with diabetes and the effects on clinical outcomes (Gillespie et al. 1998). Current literature also suggests that the...

Sulphonylurea is an oral hypoglycaemic agent which stimulates the release of insulin from the pancreas and may induce raised plasma insulin and c-peptide levels. Sulphonylurea overdose is associated with profound refractory hypoglycaemia and can cause neurological deficit and acute renal failure. We report the case of a 15 year old non-diabetic girl who presented to our emergency department with sudden onset generalised tonic clinic (GTC) seizures secondary to hypoglycaemia of...

Introduction: Continuous Subcutaneous Insulin Infusion (CSII) therapy is an established treatment of Type 1 Diabetes Mellitus (T1DM). NICE recommends a target HbA1c of ≤6.5% to minimise long-term complication risks1. CSII can be considered in patients <12 years and in those with high HbA1c (≥8.5%) on multiple daily insulin injections, despite a high level of care1. The aim of this audit is to review diabetes control over time in T1DM patie...

Introduction: Previous UK study (2009) showed that parents rather than school staff were responsible for supporting the majority of children with insulin administration (IA) whilst at school. Since then, the law has changed and the Children and Families Act 2014 (UK) places a legal duty on schools to provide the right care and support.Objective: To establish what support & facilities are available to Children & Young people (CYP) with TID whilst ...

Aims and objectives: Poor attendance in clinics remains a concern shared by diabetes services nationally and internationally. We surveyed our children’s diabetes service users to identify local reasons for non-attendance. We used the opportunity to seek feedback from service users about service design.Study population group: The group included parents/carers of children and young people who use children’s diabetes service delivered by Walsall H...

Aim: To use experience based co-design to improve the Diabetes Transition Service.Design: Young people with diabetes (type 1 and 2) managed by a district general Paediatric Diabetes Team, were invited to attend a focus group. The focus group, held in a local café, afterschool, was facilitated by two members of the Paediatric Diabetes team and the Diabetes Psychologist. A graphic designer attended to support the young people to visually explore and c...

Type 1 diabetes is a significant condition affecting school aged children with an increasing incidence in the UK. The effects of a chronic condition such as diabetes on a child can be dramatic and are particularly evident within the school setting. The impact of this condition can also be seen on parents, affecting their career, income and quality of life. Hence, this audit aims to identify the difficulties encountered by children in mainstream education, the impact of school ...

Acute Treatment-Induced Diabetic Neuropathy (ATDN) is a reversible small nerve fibre neuropathy involving pain and autonomic nerves precipitated by a rapid improvement in glycaemia. It is well described in adults with type 1 and 2 diabetes, but not in children. A 15 year old boy developed ATDN shortly after starting treatment for type 1 diabetes. He presented with polyuria and polydipsia and a blood glucose of 51.4 mmol/L. He was started on a basal bolus regime. Eight weeks la...

Project Aim: To review the data from the Out of hours service across the 8 years it has been running to identify common themes in calls, review service useage, identify gaps in patient/parental knowledge and review if admissions have reduced during this time.Objectives: • To understand the frequency of calls to the out of hours service• To highlight patterns and trends in the numbers and frequency of calls<p class...

Background: Optimizing attendance rates in outpatient’s clinics is important to ensure good clinical care and to avoid waste of scarce medical resources. In 2016, we identified a cohort of 17 teenagers that frequently Do Not Attend (DNA) the Paediatric Diabetes Multidisciplinary Clinics, compromising patient care and reducing compliance with NICE and BPT standards. As this cohort was found to be enrolled in a cluster of 5 schools we explored the benefit of taking diabetes...

Background: Structured education is offered by healthcare professionals for patients with type 1 diabetes and their families. The aims of education are to ensure competency in self-management and improve self-efficacy and glycaemic control. Therefore, this results in a reduced risk of adverse events related to diabetes and upholds quality of life.Aims: To evaluate the effectiveness of education programmes offered by healthcare professionals in Southampto...

Introduction: Several studies have described ethnic differences in HbA1c. Non-Caucasian patients have been found to have a higher HbA1c than the Caucasian ones. These differences have often been attributed to disparities in access to medical care or quality of the care. However differences in HbA1C in ethnic minorities could also relate to biological factors so we looked at mean levels of glycaemia. The aim of our study was to observe if there is a similar correlation between ...

Introduction: The Flash glucose monitoring system (FGS) has recently received a licence for children and young people aged 4–17 years with Type 1 diabetes (T1D) in the United Kingdom. Although many families attending a single UK diabetes centre reporting utilising FGS even prior to its licence we aimed to assess the patient experience.Methods: Patients and families were invited to undertake a 14 day FGS trial following group introductory sessions. 8...

Aims: We sought to audit our practice with the primary aim of improving diabetes service provision to our outpatients. Secondary Aims included developing a teaching document for junior doctors in OPD.Methodology: A retrospective audit of patient charts from monthly diabetes clinics from August to November inclusive examining our adherence to ISPAD Clinical Practice Consensus Guidelines 2014 as endorsed by BSPED.Findings: We audited...

A 17 year old young lady with known learning difficulties, dysmorphic features and ulcerative colitis presented with hyperglycaemia aged 15 years and 8 months. To diagnose her learning difficulties and dysmorphysms: Karyotype and buccal swabs were normal with no evidence of mosaic Downs, normal FISH for Smith Magenis syndrome (17p deletion), DNA testing for Prader Willi syndrome showed biparental inheritance (therefore ruling out diagnosis except in very rare cases), Fragile X...

Background: Currently only 26% of children and young people with diabetes achieve national targets. Developmentally appropriate interventions including age specific learning outcomes and goals, delivered by trained educators, which are auditable and can be integrated into routine practice are recommended to optimise the management of children and young people (CYP) with diabetes and promote lifelong self-management.Method: Health care professionals in th...

Background: NICE guideline NG18 recommends that all children aged >12 years should receive seven key care processes in order to obtain optimum glycaemic control and reduce the risk of long-term complications, which is assessed in the NPDA. In order to assess our patient population we have looked at the seven key care processes and compared to NPDA 2015/2016.Method: We collected data retrospectively on all children aged >12 years–18 years and...

Introduction: Use of degludec [tresiba] in children and adolescents with type 1 diabetes was approved by EC 2015 and FDA in December 2016. Degludec is a new ultra-long acting basal insulin with terminal half-life of approximately 25 hours and duration of action of more than 42 hours. Constant release of insulin throughout the day leads to better control of blood glucose for more than 24 hours with significant reduction in HbA1c.Aim: To compare and assess...

Background: Previous reports suggest that epilepsy and autism are more common in children with autoimmune diseases such as type 1 diabetes (T1D). While each condition is common in the general population, only small numbers of children have the two conditions together, so there is currently little coordinated support. We sought to describe the incidence in our own population.Methods: Retrospective review of the Diamond database and clinical notes for chil...

Introduction: Transition from paediatric to adult care is a challenging time for patients with long-term conditions (NICE, 2016), care should support patients to minimize further emotional, physical and social difficulties.Aims: To improve the quality of care for paediatric patients with diabetes through transition to adult care at Darent Valley Hospital (DVH). Our hypothesis is that is transitional care for diabetes at DVH meeting NICE guidelines or not...

This case series compared the efficacy of long acting basal Insulin, Insulin Degludec compared to Insulin Glargine in adolescent paediatric patients. There were seven patients in total aged 14 to 18 years. Changes in HbA1c, BMI and reduction in nocturnal hypoglycaemic episodes were compared in all seven patients. Insulin Degludec showed a decrease in HbA1C levels, particularly in patients who had HbA1C higher than 48 mmol/mol on Insulin Glargine. There was a 2.4% decrease in H...

Background: The transition from paediatric to adult care can be challenging for patients with Type 1 diabetes. Poor contiuity of care provided by the diabetes team may worsen an already difficult time for these patients. Good transition of care is vital to minimise the risk of worsening patient outcomes. In 2016, two patients failed to transition from paediatric to adult diabetes care and subsequently received no adult appointment. This breakdown of continuity of care was a re...