Endocrine Abstracts

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...

Background: Achievement of treatment targets in children and young people (CYP) with diabetes represents an important intermediary step between delivery of care and ‘hard’ outcomes such as complications. Funnel plots have been proposed as a useful tool for visualising variation in performance indicators across centers and distinguishing between common-cause (centers lying within the control limits) and special-cause variation (centers lying outside the control limits...

Background: The standard synacthen test (SST) is commonly utilised to interrogate the hypothalamo-pituitary-adrenal (HPA) axis in children. It comprises baseline and 30-minute serum cortisol concentrations (SCC), after injecting synthetic adrenocorticotropic hormone (ACTH)[1–24]. There is debate regarding the utility of a 60-minute SCC in the SST protocol with most studies to date conducted in adults.Aim: To assess the utility of a 60-minute SCC in ...

Background: We present a case of a 10 year old female with T1DM, referred to our tertiary centre for complex diabetes care due to her other severe chronic dermatological condition. We discuss the difficulties with optimizing diabetes control in such a chronic debilitating condition which has a pervasive effect on T1DM treatment.Case: To our knowledge this is only the second reported case of a child with T1DM and Epidermolysis Bullosa. Severe Recessive Dy...

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...

Objectives: To identify patient and clinical factors associated with emergency hospital admission with diabetic ketoacidosis (DKA) in children and young people with type 1 diabetes attending specialist NHS outpatient clinics in England and Wales.Design: Cross-sectional observational analysis of linked data from the National Paediatric Diabetes Audits (NPDAs) in England and Wales, and Hospital Episode Statistics and Patient Episode Database for Wales. We ...

Nephropathy remains a major diabetes related complication despite improvements in metabolic control. Current interventions are based on the appearance of albuminuria. Whether earlier detection and treatment might be beneficial is unclear. The reabsorption of low molecular weight (<70 kDa) plasma proteins in the renal proximal tubule is mediated by an endocytic receptor, megalin, and its coreceptor, cubulin.Using label free quantitative proteomics we ...

Background: Poorly controlled diabetes is associated with dyslipidaemia including high cholesterol and LDL concentrations. This increases the long term risk of atherosclerosis and cardiovascular complications. In children and young people with type 1 diabetes, management with lipid lowering agents is controversial and to date long term evidence of benefit is limited. We report a case of severe dyslipidaemia and the impact of improvement in glycaemic control.<p class="abste...

Background: Previous studies identify non-White ethnicity as predictive of poor diabetes related outcomes. However, many of these reports originate from the United States and may, in part, reflect complex interactions between ethnicity, healthcare inequality and social deprivation.Objective and hypotheses: We aimed to prospectively determine the effect of insulin intensification on glycaemic control and lipid levels in relation to ethnicity in a UK cohor...

Background: Glucagon (GST) is used as an alternative to insulin (ITT) to diagnose GH deficiency (GHD) and adrenal insufficiency (ACTHd). However the peak cortisol response to diagnose adrenal insufficiency varies (550, and 500 nmol/l), has been extrapolated from adults undergoing intraoperative stress and not fully validated.Aim: To determine the peak cortisol ‘cut off’ level which most accurately predicts clinically significant adrenal insuffi...