Endocrine Abstracts

Introduction: An HbA1c target level of 48 mmol/mol or lower in children with type 1 diabetes is recommended by the National Institute for Health and Care Excellence. Only 7.1% (national average 7.2%) of children in our unit achieved this target. In response, during a multidisciplinary diabetes away day, we explored innovative approaches to timely and efficient identification and intervention in patients with high HbA1c levels. The National Paediatric Diabetes Audit web portal,...

Introduction: Recent experience of C-peptide testing in adults with longstanding diabetes has revealed misdiagnosis of monogenic diabetes as either type 1 or type 2 with important implications for quality of life and healthcare costs. Correct diagnosis earlier in life may be possible with the use of routine antibody testing at diagnosis and c-peptide measurement 3 years after initial diagnosis. Negative or low titres for all 3 antibodies suggest non-type 1 diabetes. Persistenc...

Diabetes is a common presentation in children and young people. We describe a case of undiagnosed cystic fibrosis (CF), where diabetes was the presenting diagnosis. A 14 year old girl presented with a 2-month history of weight loss, abdominal pain, polyuria and polydipsia. Blood glucose was 31.4 mmol/l with ketones of 0.8 mmol/l, and a diagnosis of T1DM was made. Initial bloods showed HbA1c 150 mmol/mol, normal thyroid function, negative TTG, and negative TPO, GAD and IA2 anti...

Children and adolescents with Type 1 Diabetes Mellitus (T1DM) are at increased risk for developing other autoimmune diseases. We are presenting this rare association of tubulo-interstitial nephritis and uveitis (TINU) with severe hypercalcaemia and type 1 DM. 12 years old girl, with Type 1 Diabetes for 5 years presented with 4 months history of weight loss, abdominal pain, nausea, tiredness, anorexia and recurrent hypoglycaemias. Her HbA1c levels was 38 mmol/mol (5.6%). She wa...

Introduction: NICE recommends specific annual health checks for children and young people (CYP) with diabetes aged 12 years and over to check for health of feet, kidneys, thyroid and eyes in addition to BP, BMI and HbA1c. Historically, we included annual review care processes into regular diabetes multi-disciplinary clinics. In 2017, our service was identified as negative outlier in the National Paediatric Diabetes Audit for completion of health care processes. In particular, ...

Background: Our Paediatric Diabetes service has a challenging rise in proportion of patients with Type 2 Diabetes Mellitus (T2DM); 8.5% of our current cohort; compared to 3.5% regionally and 2.5% nationally (NPDA 2017–2018).Objectives: Establish a T2DM New Diagnosis Pathway and T2DM clinics aiming to achieve HbA1c < 48 mmol/mol for all new patients at 3 months and a year, with 10% weight loss.Methods: Patients diagnosed wi...

Background: Incidence of type 2 diabetes (T2DM) is increasing in children and young people under the age of 18 years. This group has a higher risk of microvascular complications and a more adverse cardiovascular risk profile than those diagnosed later. Weight loss is essential for remission, but intensive input is often required to achieve this.Aims: 1. Describe the demographics of our T2DM population2. Look at our remission rates<...

Background: Diabetic ketoacidosis (DKA) can have significant morbidity and mortality in children and young people (CYP). Its management is very well standardised, based on National Guidance (National Institute of Clinical Excellence – NICE). In the UK, CYP DKA Guidelines have been reviewed in 2015 in order to reduce the risks of cerebral oedema. There have been concerns that the new recommended fluid management has the potential to increase the risk of acute kidney injury...