Endocrine Abstracts

Introduction: Pancreatogenic diabetes (Type 3c diabetes-T3cDM) is rare in children, and frequently underdiagnosed. The prevalence is 5–10% of all adult diabetes cases in the developed world. Over 78% of people with T3cDM have chronic pancreatitis.Case: A 15-year old presented with polyuria, polydipsia, abdominal pain, weight loss (WL) and a three-generational family history of type-1 (T1DM) and type-2 diabetes mellitus (T2DM). Examination revealed m...

Introduction: Continuous subcutaneous insulin infusion (CSII) can improve glycaemic control and quality of life in Type 1 Diabetes patients. It is uncommon for paediatric patients to discontinue CSII and return to multiple daily insulin injections (MDI) often due to concerns regarding worsening metabolic control. However a trial off CSII is a requirement before transition to the adult clinic. We review the outcomes of those who discontinued CSII in our centre (total 248 patien...

Background: Raised blood pressure (BP) in adolescents with type 1 Diabetes Mellitus (T1DM) has been associated with adverse cardiovascular outcomes independently of raised HbA1c. It is therefore of critical importance that these patients are identified early and appropriate treatment instigated. Of concerns, studies have recognised suboptimal management of hypertension in most of these young people, allowing them to succumb to complications of diabetes with hypertension in the...

Retinopathy is one of the more serious complications of type 1 diabetes. There is emerging knowledge re the development of retinopathy in childhod diabetes. We studied the clinical profiles of children with retinopathy in an industrial town in Northern England. The current clinic size is 160. 42 patients were identied from clinic records as having retinopathy. Formal screening is offered to all patients from age 12. The age range was 11–20 years; median age 16. 55% were f...

Introduction: The management of type 1 diabetes (T1D) in young children can be extremely challenging due to high insulin sensitivity, unpredictable eating and activity and difficulty recognizing symptoms of hypoglycaemia. Continuous subcutaneous insulin infusion (CSII) therapy is beneficial in managing young children, however the small insulin doses required challenge the accuracy of standard concentration (100 IU/ml) CSII.Case report and literature revi...

Objectives: Children and young people (CYP) with Type 1 Diabetes Mellitus (T1DM) are at risk of acute clinical emergencies. Wearing medical identification (ID) is recommended by the National Institute for Clinical excellence (NICE). Information on adherence to this recommendation in CYP with T1DM is scarce. This study aimed to assess parent and CYP’s knowledge of the recommendation, to explore adherence and barriers to carrying ID and understand preferred forms of ID....

Aim: Type I Diabetes Mellitus is a chronic metabolic disorder with an incidence of 24,000 children in the UK. NICE has recommended the use of the sensor augmented pump (SAP) in managing short and long term diabetes related complications. Limited literature is available in the paediatric population. SAP is designed to allow continuous glucose monitoring, with real-time adjustment of insulin; making it superior to other pump systems. 0.8% of children suffer from Type I DM in the...

Introduction: Recently a serious incident due to failure in rechecking blood glucose (BG) after hypoglycaemia treatment was reported in an adult inpatient. We evaluated adherence to network guidance on hypoglycaemia management in inpatients and changes in practice following an intervention based on education and system changes.Methods: In an audit (audit-1), hypoglycaemia episodes (BG level <4 mmol/l) were identified in paediatric inpatients (age &#6...

Background: Our Diabetes Team look after approximately 220 T1DM patients aged 0–17 years. In 2014/15 NPDA we ranked amongst the top 5 paediatric units with mean HBA1c <65 mmol/mol. Susequently our ranking slipped, with increased mean HBA1c and fewer patients achieving HBA1c <58 mmol/mol.Objectives: We recognised a particular problem with poor control in the first year after diagnosis and identified the need to drive change to be able to achi...

Introduction: Hypoglycaemic episodes (Hypos) can happen at any time in type 1 diabetes patients; sometimes quite unpredictably. Carrying ‘hypo supplies’ at all times is basic to good diabetes care; often delegated to parents for children with diabetes. The primary aim was to assess how this basic care activity is practised in real life; secondary aim was to correlate lack of hypo supplies with diabetes control or other patient characteristics.M...

Introduction: Gloucestershire Paediatric Diabetes Team has implemented several innovations including carbohydrate counting from diagnosis, annual review clinics and family events. We seek to improve our patient engagement and experience to improve health outcomes.Aim: Improve the clinic experience for patients, their families and staff, based on their input, thereby encouraging greater engagement and patient attendance as part of the RCPCH quality Improv...

Aim: To empower our patients/parents to self-manage Type 1 diabetes (T1dm) by providing them with required knowledge and skills.Method: We identified 10 motivated, mostly newly diagnosed T1dm patients and their families. We organised a master-class to educate them on how to use DIASEND to review blood sugars, identify patterns and adjust Insulin doses. We conducted weekly DIASEND clinics for 6 weeks and fortnightly for another 6 weeks (phone call/email)....

Background: 71/270 (26%) of our patients with T1DM, diagnosed for more than 1 year, had an ideal HbA1c of less than or equal to 48 mmol/mol. Are there factors within this group that may be transferred into groups with higher HbA1cs to improve control?Methods: Clinical records were reviewed for the whole year and download data from a randomly selected 2 week period was reviewed. Age, gender, time from diagnosis, ethnicity, postcode, other medical conditio...

Introduction: Optimal care in Type 1 Diabetes (T1DM) requires intensive insulin management with regular dose adjustments. A Download clinic (DC) was created for all patients attending the Paediatric Diabetes clinic. Patients downloaded their glucometers, pumps and Continuous Glucose Monitors (CGM) either at home or hospital. After analysis, the diabetes team provided feedback by email and phone.Objectives: To analyse the effects of the DC on the metaboli...

Introduction: Type 1 diabetes (T1DM) occurs as a result of autoimmune destruction of pancreatic β-cells which is supported by the presence of autoantibodies well before the onset of T1DM. Individuals at risk for T1DM are characterised by a deficient first-phase insulin response and impaired glucose tolerance which is present before the onset of T1DM.Case: We describe a case of 6 year-old asymptomatic girl who took part in the TrialNet Pathway-to-Pre...

Introduction: The aim of having an away day was to enhance relationships across three sites by improving the understanding of each other’s roles, their contributions and ways to provide mutual support. Also the intention was to establish parity through co-designing common practices of working effectively and developing quality improvement projects.Method: Staff members from three Paediatric Diabetes Teams within the same trust were invited to attend...

Introduction: Young people with type 1 diabetes (T1DM) face great challenges in managing their disease. Puberty poses strains on glycaemic control. Transferring from paediatric to adult diabetic services is another obstacle. The study aims to evaluate our local transition and transfer service provision and monitoring of the young people’s HbA1c control during this challenging period.Methods: T1DM patients transferred from our hospital’s paediat...

Objectives: The Diabetes Team at Birmingham Children’s Hospital modified the advanced bolus algorithm suggested by Bell (2015), to develop the KISS (Keep it Simple and Safe). KISS involves adding 25% extra insulin to meals identified as very high fat and protein, and spreading the insulin by a split bolus, 50% now and 50% over 2.5 hours. KISS also has an adjustment tool allowing extra insulin to be added and the split modified from monitoring. KISS is intended to be a sim...

Objectives: To evaluate the usefulness of an Annual Review Questionnaire (ARQ) which was introduced as a clinical tool to assess Knowledge and Compliance of Children and Young People (CYP) with Type 1 diabetes with aspects of good clinical care as defined by National Institute of Clinical Excellence (NICE) guideline.Methods: All CYP with Type 1 diabetes, were expected to complete the ARQ as part of annual review. The questionnaire asked about compliance ...

Introduction: A 7 year old boy with history of Joubert’s syndrome presented with first presentation of type 1 diabetes mellitus in Diabetic ketoacidosis (DKA) and a hyperglycaemic hyperosmolar state (HHS). His underlying neurological condition made clinical assessment difficult and he had reduced GCS with intermittent apnoeas but no respiratory compromise. Using the BSPED guideline (2015) for DKA he was managed with cautious fluid replacement despite his hyperosmolar stat...

Introduction: Diabetic Ketoacidosis (DKA) is a life-threatening complication of Type-1 diabetes mellitus (T1DM) in children and young people (CYP). An Integrated Care Pathway (ICP) for management of DKA is established in Wales with the 3rd edition published in March 2016. This is based on the 2015 British Society for Paediatric Endocrinology and Diabetes (BSPED) guidelines.Aims: To audit the management of DKA in a teaching hospital following the introduc...

Introduction: Poorly managed transition could adversely impact upon adjustment to diabetes and potentially result in non-adherence to treatment, loss to follow-up and worsening of health-related outcomes. In our DGH, approximately 20 Young Person (YP) with T1DM get transferred to YP Clinic every year. YP between 17–19 years of age attend a joint clinic before the transfer. The YP Clinic provides a continuity of diabetes care up to the age of 25 years.<p class="abstext...

Aims: To understand whether insulin treatment for type 1 diabetes mellitus (T1DM) in the paediatric population is most effective at providing diabetic control when delivered by Multiple Daily Injections (MDI) as compared to Continuous Subcutaneous Insulin Infusion (CSII).Methods: A District General Hospital’s submissions to the National Paediatric Diabetes Audit (NPDA) between 2012 and 2018 were analysed to establish if either method of insulin deli...

Background: There is an increased incidence of Type 1 diabetes in preschool children and the management of diabetes in this group is challenging. Preschool children are dependent on others for all aspects of their care. Normoglycaemia in preschool children reduces the likelihood of acute and chronic complications.Objectives: Our goals were to:1. Outline the demographic characteristics of children diagnosed with diabetes before 5 ye...

Background: As per 2011–15 National Paediatric Diabetes Audit (NPDA) data set, the paediatric diabetes units (PDU) contributed data on annual lipids levels check for children and young people (CYP) over 12 years of age. Blood cholesterol were used to stratify the risk of complications of diabetes. National Institute of Health and Care Excellence (NICE) guideline NG18 did not recommend lipid screening during annual review of type 1 diabetes due to lack of robust evidence. ...

Introduction: This is an audit on the outcome of children and young people (CYP) with Type 1 Diabetes with high HbA1c who were offered extra appointments with a paediatric diabetes specialist nurse (PDSN) over a three-year period at Harrogate District Hospital.Patient population: 26 CYP with Type 1 Diabetes with HbA1C more than 75mmol/mol, were offered extra diabetes clinic appointments with a PDSN.Audit Methodology: A retrospectiv...

Background: During 2017–2018 the diabetic team at our Foundation Trust participated in the RCPCH diabetes quality improvement collaborative to support work in reducing the mean HbA1c of our patient cohort. It is widely acknowledged that a consistent approach is vital in working towards HbA1c targets. One area of focus of our quality improvement work was to standardise the management of hypoglycaemia. As a team we decided to follow the BSPED hypoglycaemia guideline (2016) ...

Introduction: ‘Transition’ is the period of movement from paediatric to adult healthcare. These patients are in their adolescence when the brain is maturing, causing changes in behaviors including greater risk-taking. The period of transition can be associated with poor adherence to insulin and blood glucose monitoring regimens and an increased risk of diabetic ketoacidosis (DKA). This study looks into how effective our transition programme has been at addressing thi...

AbstractThe psychosocial impact of diabetes in childhood is ubiquitous and involves the entire family, as well as schools and society as a whole. The International Society for Pediatric and Adolescent Diabetes (ISPAD) developed guidelines in 2000 to assist health professionals in the management of young people with diabetes. These guidelines are based on the St. Vincent Declaration, the Declaration of Kos, and the Declaration of the Americas, which defin...

Background: Self-management of Type 1 diabetes (T1DM) is difficult and complex, particularly so during the transition period. Deterioration in glycaemic control is common, in part due to psychosocial and environmental changes (going to college or university), poor adherence to insulin regimens, risk-taking behaviours and family stressors. Transition to adult diabetes services can be a traumatic period for young people with diabetes, who commonly fall between services and are l...

Introduction: A case series of three children diagnosed with MODY at a university hospital between November 2015 and May 2018. All of them was found to have HNF1B mutation.Background: HNF1β-MODY (MODY5) is a rare form of monogenic diabetes that is often associated with a wide range of urinary tract anomalies including renal cysts. It’s a dominantly inherited disease including maturity-onset diabetes of the young (MODY), pancreatic insufficiency...

Introduction: Children with Down’s Syndrome (DS) have altered immunity with higher rates of diabetes, thyroid autoimmunity, coeliac disease, respiratory tract infections and leukemia. Diabetes in children with DS appears to be accelerated with an earlier age of onset compared with the general population, with 22% diagnosed before the age of 2 years. Increased HLA class II DR3/4 susceptibility is seen in in children with DS and diabetes but the prevalence is reduced compar...

Aim: To investigate the trend of HbA1c levels of newly diagnosed type 1 diabetes paediatric patients in Gloucestershire Hospitals NHS Foundation Trust.Methodology: The Infoflex diabetes database was used to collate information on the type 1 diabetes paediatric patients, diagnosed in Gloucester NHS Trust between September 2015 and December 2017. The cohort totalled 74. Their HbA1c levels at diagnosis, 4–7 weeks, 3–4 months, 6–8 months and 1...

Introduction: Insulin Dugludec is an ultra- long acting basal insulin. The management of diabetes in children is challenging due to the need of regularly injecting insulin, risk of hypoglycaemia, variation in the activity of different insulins available. Dugludec has a long half-life (25 hrs), lower variability and lasts 42 hours. Currently there are no guidelines or NICE recommendations advising the use of insulin dugludec in children with diabetes. Studies are few but have s...

Introduction: MODY is a group of monogenic disorders contributing to about 1% of diabetes due to a primary defect in the function of the beta cells of the pancreas. Although increasingly recognised, it is often misdiagnosed as type 1 or Type 2 Diabetes Mellitus(T2DM). We describe 7 cases of MODY of which 6 were genetically confirmed.Case reports: Siblings with loss of function mutation of ABCC8 gen. 2 brothers were diagnosed to have diabetes at 15 and 12...

Introduction: Patients who have diabetes are at risk of complications, both acutely and in the long term. Although care is individualised, it may not be practical to continuously review this on an individual basis. An audit evaluating outcomes is a useful tool to reflect on multidisciplinary team management. We describe how effective use of resources led to better results in a multi-ethnic population.Population: A total of 130 children and young people w...

Introduction: NICE NG18 recommends level 3 carbohydrate counting from diagnosis for CYP diagnosed with Type 1 Diabetes. Our unit introduced in-patient level 3 carb counting from day 1 in 2015 in response to an audit demonstrating sub-optimal control in the first year of treatment.Methods: We carried out a longitudinal study of HbA1c in paediatric patients during the first year of diagnosis in two time periods, before and after the introduction of carb co...

The management of children and young people (CYP) with diabetes is forever evolving, with tools and management strategies becoming much more intense. Year on year this has led to an overwhelming burden of educating schools when providing training for over 300 patients with type 1, type 2 and rarer types of diabetes. Children spend on average 1,267.5 hours per year in school – it is essential children’s diabetes management is optimised during this time, and health car...

Objectives: The purpose of this study was to review the effectiveness of the Freestyle Libre flash glucose monitoring system at improving glycaemic control in a paediatric clinic.Methods: Data from 13 participants with type 1 diabetes for the first 3 months of use of the Freestyle Libre system either continuously or intermittently was collected using both clinic readings of glycated haemoglobin (Hba1c) and from the Libre itself using the Diasend diabetes...

Introduction: The period of adolescence for young people (YP) with diabetes is a significantly high-risk time and is linked with worsening metabolic control, non-adherence to treatment, and increased risk of mental health issues. Arranging an efficient and smooth transfer for young person with type 1 diabetes (T1DM) from paediatric to adult care is one of the great challenges facing the diabetes multidisciplinary teams.Aim of the study: This audit looks ...