Endocrine Abstracts

Introduction: In many lower-middle income countries (LMICs), poverty, insufficient infrastructure and lack of universal health coverage affect type 1 diabetes (T1D) outcomes. Limited insulin and unavailability of blood glucose monitoring supplies contribute to poor glycaemic control and T1D complications that adversely affect mortality and morbidity. Laos is a LMIC in Southeast Asia (SEA) with a population of 7.3 million. Its GDP per capita is USD 2,534 of which only 2.5% repr...

Introduction: Globally, the main cause of mortality of type 1 diabetes (T1D) is lack insulin access. There is minimal data of health outcomes for T1D in low-middle-income countries (LMICs) in South-East Asia (SEA) where government funding of insulin and blood glucose monitoring kits either do not exist or is limited. Action4Diabetes (A4D) is a non-government organisation (NGO) initiated in 2016 and supports children and young people (CYP) with T1D in five countries -Laos, Mala...

Background: Reports from several countries have suggested an increased incidence of diabetic ketoacidosis (DKA) at presentation of type 1 diabetes mellitus (T1DM) during the COVID-19 pandemic. Published data on this from the United Kingdom is sparse. We examined the frequency and severity of DKA at diagnosis of T1DM in children presenting to a university hospital during the first year of the pandemic in comparison to preceding years.Methods: In England, ...

Introduction: National guidance recommends Level 3 carbohydrate counting (L3CC) is delivered within 2 weeks of diagnosis of Type I Diabetes Mellitus (T1DM) (NICE, 2015). This was introduced at Derbyshire Children’s Hospital in 2017. This service evaluation aimed to assess the impact of this on patients’ blood glucose, by recording HbA1c levels at quarterly intervals over 6 months. Methods: A comparison of quarterly HbA1c in children that receiv...

Background: Prior to COVID-19, HbA1C was performed in clinic as a point of care test. As a service development project driven by the changes to our service from COVID-19 we offered either a hospital drive through point of care HbA1C test or the validated VAMS collection method to obtain HbA1C at home.Objective: Research ethics approval was obtained to assess patient/carer acceptability of these collection methods.Methods: Drive thr...

Background: Children and young people (CYP) with Type 1 diabetes are offered 4 face to face appointments annually. During the COVID-19 pandemic these were delivered virtually.Objective: We conducted a survey to assess patient and carer satisfaction with the remote diabetes service. Methods: Research ethics approval was obtained. The survey was distributed to 280 CYP and their families; one response per family was collected. Data on...

Introduction: Achieving an HbA1c of less than 48 mmol/mol minimises the risk of complications in children and young people with type one diabetes. Elective admissions to hospital are one option employed to improve glycaemic control in patients with an HbA1c above target. There is however limited evidence to support such admissions. We aimed to retrospectively compare glycaemic control between patients electively admitted to hospital to stabilise their dia...

Thiamine-Responsive Megaloblastic Anaemia (TRMA) is a rare autosomal recessive disorder emerging due to mutation in the thiamine transporter 1 gene. It presents with sensorineural hearing loss, non-immune diabetes mellitus and megaloblastic anaemia. Ocular manifestations of TRMA described so far include optic atrophy and cone-rod retinal dystrophy. This case-report presents an adolescent British-Pakistani boy with TRMA, who was unexpectedly diagnosed with bilateral severe prol...

Introduction: Frimley Park Hospital, Surrey had been a negative HbA1c outlier for 3 consecutive years. The Children’s and Young People’s (CYP) diabetes team embarked upon the RCPCH National CYP Diabetes Quality Improvement (QI) Programme in November 2019. There was little qualitative data on ward nurse education, however, experience revealed engagement in staff training was the main barrier. Although regular education sessions were available to ward staff, attendance...

Background: Current guidance recommends screening for coeliac disease (CD) at diagnosis of type 1 diabetes mellitus (T1DM) using measurement of serum anti tissue transglutaminase immunoglobulin A (tTG-IgA). It is recognized that tTG-IgA levels can fluctuate and there are reports of transient rises in tTG-IgA levels in response to acute stress, such as infection and acute coronary syndrome. The effect of diabetic ketoacidosis (DKA) on tTG-IgA has not been reported. We investiga...

Background: Telemedicine use has increased rapidly during the COVID-19 pandemic, replacing many face-to-face (FTF) consultations. FTF consultations are associated with increased CO2 emissions (CO2em) from travel to clinics. This study evaluates the triple bottom line of children and young people’s (CYP) and parent or guardian experience of a new telemedicine service, estimated CO2em saving from reduced travel and cost saving to families.Methods: Dat...

There is little evidence of glycaemic control changes in Paediatric patients with diabetes during pandemics or natural disasters. We were interested in analysing and comparing the HbA1c values in children and young people with diabetes at West Hertfordshire NHS trust before the covid-19 pandemic in 2019-2020 and during lockdown in 2020-2021. Our hypothesis was that there would be a deterioration in HbA1c outcomes and a reduction in the number of tests done in 2020-2021. We ass...

The use of digital technology to improve accessibility and efficiency of services has been recognised and telemedicine has been increasing over recent years, particularly for patients with chronic conditions such as diabetes. The onset of the COVID-19 global pandemic rapidly accelerated the use of virtual consultations into everyday practice. The aim of this study was to assess feedback from paediatric diabetes patients and their parents regarding virtual consultations. The st...

Background: Nutrition of the children and young people with type 1 diabetes mellitus is considered a major aspect of glycaemic control and it represents a big challenge in their management. Among the different perspectives of nutritive interventions for diabetic children, there has been a debate over the recommendation of low glycaemic index diet for them. There has been debate over the efficacy of Low GI foods on diabetic patients blood glucose control. Nevertheless, Evidence...

Background: “Diabetes (type 1 and type 2) in children and young people: diagnosis and management” guideline (NICE NG18, 2015) stipulates following “Coeliac disease: recognition, assessment and management” guideline (NICE NG20, 2015) for follow up children and young people (CYP) with diabetes and coeliac disease. NG20 advocates against checking coeliac antibodies on yearly basis if compliance with gluten free food is confirmed by dietary review. In 2016, we ...

Background: The transition period is a challenging time for adolescents and is frequently associated with deterioration of HbA1c, decreased attendance, and disengagement from services. Two London hospitals both have existing transition programs to facilitate the movement of patients with diabetes from paediatric to adult care services.Aim: This audit aimed to assess mean HbA1c values, HbA1c monitoring frequency, and appointments offered and attended in t...

Background: During the pandemic, children and young people (CYP) have been in social isolation and faced many changes to their normal routine. Limited research has been done to understand how CYP with diabetes have been affected.Objective: The objective of this study was to understand how CYP with diabetes have been affected by the COVID-19 pandemic.Methods: Questionnaires were produced which included both quantitative and qualitat...

Introduction: Diabetic ketoacidosis (DKA) remains a common presentation of type 1 diabetes (T1D) in children. During the COVID-19 pandemic, rates of presentation in DKA increased. Electrolyte abnormalities can occur during DKA treatment, but they are uncommon at presentation. We report a teenage girl with new-onset T1D presenting in severe DKA, complicated by profound hypokalaemia and hypernatremia. Case Report: A previously healthy 13-year-old girl was ...

Introduction: Recommended starting insulin doses in CYP with newly diagnosed type 1 diabetes vary widely from 0.3 to 1.0 U/kg/day. However, there is no study for rate of change of insulin dose in first few months of initiating insulin.Aim: Retrospective review of insulin total daily dose at diagnosis, hospital discharge, and at first clinic, documenting changes in % basal insulin with time, considering any impact of insulin treatment on body weight and H...

Background: • Updated guidance on management of DKA in 2020.• Main changes: &cir; Diagnostic Criteria &squf; same ketone/pH criteria but serum bicarbonate level lower (<15 mmol/l) &cir; Severity: &squf; pH <7.3 or bicarb <15=Mild DKA pH <7.2 or bicarb <10=Moderate DKA<p cla...

Background: Poor diabetes control is associated with increased risks in all types of hospital admission. Admission into hospital among children and young people with diabetes places a large burden on the NHS resources. For example the cost of a DKA stay per patient is £20641.Introduction: We analysed the paediatric admissions to hospital of those in T1DM. Our objective was to compare our type of hospital admissions to the national paediat...