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Endocrine Abstracts

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44th Meeting of the British Society for Paediatric Endocrinology and Diabetes

Poster Presentations

Diabetes

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Gonadal, DSD and reproduction

ea0045p12 | Diabetes | BSPED2016

Identifying the barriers to effective diabetes ‘transitional care’. A qualitative study of patient satisfaction and experiences of transition

Wilson Kate , Ashford Jennifer , Olsen Paula , Slegtenhorst Sonja , Williams Rachel , Acerini Carlo L

Disparities in the quality of care for patients with type 1 diabetes (T1D) undergoing transition from children’s to adult services are well recognised. Poor planning and ill-defined care pathways promote patient disengagement with many becoming ‘lost’ to specialist follow-up for years. This study sought to obtain the views of young people’s experiences of transition to identify perceived barriers to an effective and rewarding transition experience. A qualit...
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ea0045p13 | Diabetes | BSPED2016

Practical Elements for Successful Recruitment of Patients and Families with Newly Diagnosed Type 1 Diabetes (T1DM) into a Research Study

Saddington Caroline , Mohamed Zainaba , Sachdev Pooja , Denvir Louise , Randell Tabitha

Background: The paediatric diabetes team at our Children’s Hospital were part of a national clinical trial considering whether long term outcomes are better for patients on MDI (multiple daily injection therapy) or insulin pump therapy from diagnosis. Patients and their families had to be approached, consented and treatment for the trial commenced within two weeks of diagnosis. Many centres struggled to recruit, but this was not the case with our centre.<p class="abst...
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ea0045p14 | Diabetes | BSPED2016

Identifying the barriers to diagnosing type 1 diabetes in young people in the primary care setting

Suo Chenqu , Wilson Kate , Acerini Carlo

Objectives: In the UK the majority of young people presenting for the first time with signs and symptoms of type 1 diabetes (T1D) are initially seen by general practitioners (GPs). Mis- or delayed diagnosis is not uncommon, and it increases the risk of diabetic ketoacidosis-related morbidity. This study seeks to identify the specific challenges faced by GPs in this setting in order to develop effective care pathways and recommendations for improving the timely diagnosis of T1D...
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ea0045p15 | Diabetes | BSPED2016

Severe acute renal failure requiring dialysis in children with diabetic ketoacidosis

Paraskevopoulou Evagelia , Peacock Amanda , Patel Leena , Burren Christine , Yong James , Bain Murray , Wei Christina

Introduction: Acute renal failure (ARF) is a rare but life-threatening complication of severe diabetic ketoacidosis (DKA) in children.Aim: To characterise the presentation, treatment and clinical course of children with DKA complicated by severe ARF requiring renal support.Method: Retrospective notes review of patients aged <16 years admitted in 2011–2016 to 3 UK regional paediatric intensive care units (St George’s H...
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ea0045p16 | Diabetes | BSPED2016

An Audit of the Paediatric Diabetes Out Of Hours Advice Service using the Best Practice Tariff Criteria

Starr Emma , Quintela Ella , Denvir Louise , Sachdev Pooja

Background/Introduction: The Best Practice Tariff was introduced in 2012 in England and Wales to provide adequate funding and ensure quality care for all children with Diabetes. The tariff criteria states that units must provide “24 hour access to advice and support” including “24 hour expert advice to other healthcare professionals”. The aims of this audit were to: evaluate the Nottingham Children’s Hospital out of hours paediatric diabetes service, d...
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ea0045p17 | Diabetes | BSPED2016

Acute surgical abdomen masquerading as diabetic ketoacidosis

Kanumakala Shankar , Fonseka Geetha , Karunaratne Irantha , Alexander Nicholas

Introduction: Diabetic ketoacidosis (DKA) can be easily confirmed with the triad of hyperglycaemia, metabolic acidosis and ketonaemia/ketonuria when suspected. DKA presenting as acute abdomen sometimes is well known, but not vice versa. We describe a rare presentation of acute abdomen with stress hyperglycaemia masquerading as DKA.Case Report: 2 year old boy presented with abdominal pain for 8 hours, vomiting & lethargy and tachypnoea & tachycard...
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ea0045p18 | Diabetes | BSPED2016

Hypoglycaemia – are children carrying the right sugars?

Gibbons Luke , Hakeem Vaseem

Objective: Assess whether attendees to a paediatric diabetes clinic are carrying their blood-glucose monitors and short-acting glucose to identify and treat hypoglycaemia.Background: The National Institute for Health and Care Excellence recommends children with type 1 diabetes should always have access to blood-glucose monitoring and a fast-acting glucose to treat episodes of hypoglycaemia. This study assessed the paediatric population at Barnet and Chas...
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ea0045p19 | Diabetes | BSPED2016

It’s all about the HbA1cs but don’t forget the LFTs…

Curran Grainne , Abid Noina

Introduction: Mauriac first described a syndrome in 1930 of growth failure, delayed puberty and hepatomegaly in children with type 1 diabetes. This was in the era prior to long acting insulin analogues being available. With the now widespread availability of various insulin analogues and near patient testing to optimise glucose control, this syndrome was presumed to be of historical interest only. There are increasing reports in the literature of the resurgence of this once fo...
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ea0045p20 | Diabetes | BSPED2016

Acute mononeuropathy as a first presentation of Type 1 Diabetes Mellitus

Kapoor Sonal , Sundaram Prem , Tziaferi Vaya , Prasad Manish

Introduction: Diabetic neuropathy is often a late manifestation of diabetes. Moreover its incidence in the paediatric age group is very rare. We present here a case of motor neuropathy as a first presenting feature of Type 1 diabetes mellitus.Case Report: A fourteen-year-old girl presented with right foot drop, which had progressively worsened over the last ten days. There was no other CNS or systemic involvement. Parents denied any history of pain, para...
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ea0045p21 | Diabetes | BSPED2016

Efficacy and uptake of an education clinic integrated into an MDT clinic for children with type 1 diabetes

Quintela Ella , Drew Josephine , Denvir Louise , Randell Tabitha , Sachdev Pooja

Introduction: The Best Practice Tariff states that units must provide a structured education programme which should be ‘tailored to the child’s needs, both at the time of initial diagnosis and ongoing updates’. Traditionally, there has been poor uptake of our education sessions with attendance rates of 20% (range 0–30). Therefore, an integrated education clinic was introduced which combined education within a multidisciplinary (MDT) clinic session for ongoi...
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ea0045p22 | Diabetes | BSPED2016

Structured education and competency in adolescents and families with type 1 diabetes mellitus (T1DM)

Parmar Meera , Davis Nikki

Background: The Paediatric Diabetes Team at Southampton Children’s Hospital provide a home annual review service for children with T1DM led by Paediatric Diabetes Specialist Nurses. They provide patients and families with support, advice and re-education. Service-users have reported positive feedback regarding effectiveness and relevance of education provided. However, many patients, particularly adolescents, still suffer reduced quality of life (QOL) and life-threatening...
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ea0045p23 | Diabetes | BSPED2016

Unusual presentation of a rare netabolic disorder in an adolescent with T1D with recurrent DKA and steatohepatitis

Gangadharan Arundoss , Paul Princy , Venkatesh Krishnappa , Morris Andrew , Kerr Sue , Ghatak Atrayee , Senniappan Senthil

Introduction: Early onset diabetes mellitus and poor glycaemic control can predispose to various long-term complications. NICE recommends regular assessment starting at 12 years of age to diagnose micro/macro vascular complications and neuropathy for appropriate management. Rare undiagnosed metabolic disorders could pose diagnostic and management challenges. We report an unusual presentation of a rare metabolic disorder in an adolescent with type-1 diabetes mellitus (T1D)....
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ea0045p24 | Diabetes | BSPED2016

A case of Mauriac Syndrome

Danda Nandita , Tharian Kavitha

Mauriac syndrome is a rare complication of poorly controlled type 1 diabetes (T1D) characterized by growth failure, hepatomegaly, elevated transaminases and cushingoid features. We report a case of an eleven year old boy with Mauriac syndrome.Case Study: An eleven year old Caucasian boy, known to have T1D from 7 years of age with poor glycaemic control and high HbA1c noted to have abdominal distension with hepatomegaly at his clinic visit. It was also no...
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ea0045p25 | Diabetes | BSPED2016

Management of Paediatric Diabetic Ketoacidosis: An Audit

Gollins Charlotte , Javed Muhammad , Muhammad BJ

Introduction: NICE Guidelines NG18 (published 2015) advocate a more conservative approach to management of diabetic ketoacidosis (DKA) in children and young people up to the age of 18, in an attempt to reduce the risk of cerebral oedema.We aimed to assess if management of DKA in children at Manor Hospital was compliant with hospital guidelines, that were based on BSPED guidelines (issued 2009). We analysed the difference in total fluid administered if th...
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ea0045p26 | Diabetes | BSPED2016

Ensuring complete data for the national paediatric diabetes Audit – An Approach Using Python

Price Victoria , Shah Akhil , McGuigan Michael

Introduction: Diabetes teams need to keep electronic data records for supporting participation in the National Paediatric Diabetes Audit (NPDA), and other governance activities. NPDA benchmarks diabetes services against each other, and services are keen to make sure their data is accurate so that it gives a good reflection of their service. Twinkle is a specialised database that is widely used for this purpose.Twinkle allows units to produce specific rep...
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ea0045p27 | Diabetes | BSPED2016

Audit of screening investigations and delay in referral for children with newly diagnosed type I diabetes

Coxson Edward , Balapatabendi Mihirani

Aim: To audit the current practice of investigations for children presenting with type I diabetes in our centre and identify delays in referral to secondary care.Standards: Guidelines published by ACDC: Care of the well child newly diagnosed with type I diabetes, NICE: “Diabetes (Type I and Type 2) in children and young people” August 2015 and local trust guidance “Paediatric diabetes - management of newly diagnosed well child”.<p...
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ea0045p28 | Diabetes | BSPED2016

Lessons learnt from a case of childhood obesity with Hyperosmolar Hyperglycaemic state (HHS) and severe acidosis

Lim Sharon

Case: A 14 year-old boy was found semiconscious by his mother following difficulty in sleeping overnight as he felt intermittently hot and cold. He had intentionally tried to lose weight (about 25 kg over 6 weeks). Presenting weight was 81 kg. Following prolonged resuscitation at home, GCS was 12 on arrival to hospital, 8 when intensive care team arrived. pH was <6.9 throughout. First venous glucose was 80 mmol/l (unrecordable on gas and glucometer), first plasma Sodium 11...
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ea0045p29 | Diabetes | BSPED2016

Audit on metabolic effect of insulin pump therapy vs. pen for children with Type 1 Diabetes

Beckett Rachel , Abid Noina

Background: Insulin pump therapy has been linked to improved HbA1c levels, reduced frequency of severe hypoglycaemic episodes and reduced rates of Diabetic Ketoacidosis compared to treatment with multiple daily injections. Insulin pump therapy was started in 2008 in our unit.Aims: To compare the metabolic effect of insulin pump therapy vs multiple daily injections via pen devices in children with type 1 diabetes in our unit.Method:...
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ea0045p30 | Diabetes | BSPED2016

A case of neonatal Diabetes: Diagnostic and management challenges

Beckett Rachel , Abid Noina

We present a patient who was incidentally diagnosed with neonatal diabetes at 4 months of age. Due to his small size his treatment has posed a number of challenges for our team.Case Report: A 4 month old boy presented to the Emergency Department with a petechial rash on his legs. Investigations revealed elevated blood glucose of 26.7 mmol/l but a normal pH of 7.39. He had glycosuria but no ketonuria. There was no history of weight loss or osmotic symptom...
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ea0045p31 | Diabetes | BSPED2016

Introducing Dedicated Annual Review Clinics for Children with Type I Diabetes Mellitus in Gloucestershire: Results from a two-year service improvement and evaluation

Coxson Edward , Hawksley Jessica , Unsworth Rebecca , Balapatabendi Mihirani

Introduction: In 2014 the diabetes multidisciplinary team at Gloucestershire Royal Hospital Foundation Trust introduced dedicated annual review clinics for children with type I diabetes over the age of 8 years. Children receive their Consultant appointment, foot check, annual review bloods and structured education sessions in a single afternoon clinic visit. We present the results of two annual service evaluation projects, which have helped us improve the clinics and allowed u...
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ea0045p32 | Diabetes | BSPED2016

Emergency advice for families of children with diabetes – the story of a helpline

Grosser Sabine , Alexander Vicky

Objective: To describe the changes in out-of-hours emergency advice to families of children with diabetes over the last 15 years, the reasons for change and impact on hospital attendance.The local emergency clinical helpline for children with diabetes (DiabNet) was discontinued in August 2015. We have looked at its service and how it informed the support we deliver today, especially out of hours advice provided currently by paediatric registrars.<p c...
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ea0045p33 | Diabetes | BSPED2016

Does increase in funding and service provision improve outcomes of patients with diabetes? An evaluation of HbA1c in paediatric patients with diabetes at Peterborough City Hospital

Keene Eleanor , Puthi Vijith , Kent Alison

Objectives: In April 2013 a new payment tariff was introduced to enable better funding and comprehensive provision of paediatric diabetes care. We aimed to assess if this new tariff and increased resources have improved glycaemic control in children with diabetes.Methods: This was a retrospective analysis of HbA1c, insulin requirements and BMI in all patients under the care of the paediatric diabetes team at a district general hospital for at least 1 yea...
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ea0045p34 | Diabetes | BSPED2016

Continuous Subcutaneous Insulin Infusion results in better glycaemic control and reduced insulin requirements in CFRD: Report of 2 cases in children

Trewella E F , Spowart K , Nambisan A Kesavath Raman , Nolan SE , Carr S , Balfour-Lynn I M , Alexander Saji , Bridges Nicola

Introduction: Continuous Subcutaneous Insulin Infusion (CSII) has several advantages over Multiple Daily Injections (MDI) including better hourly delivery and avoidance of injections. However usage of CSII is significantly less in Cystic Fibrosis Related Diabetes (CFRD) compared to type 1 diabetes and published literature on use of CSII in children and adolescents with CFRD is minimal.We report two cases where CSII was used in CFRD resulting in a lower T...
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ea0045p35 | Diabetes | BSPED2016

Assessing the impact of a youth worker on diabetes care in adolescents with type 1 diabetes

Peacock Amanda , Guest Matthew , Cropper Julie , Trentham Sarah , Clarke Michelle , Yong James , Campbell Fiona

Background: The inclusion of a youth worker within a transition service can be pivotal to its success.Objective: To assess the impact of a youth worker on diabetes care in adolescents with type 1 diabetes (T1DM) over a 6 month period by measuring HbA1c levels (primary outcome), Personal Development Tool score (PDT), hospital admissions and clinic attendance (secondary outcomes).Method: Prospective cohort study. 20 adolescents (age ...
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ea0045p36 | Diabetes | BSPED2016

A critical review of type 1 diabetes new patient education programme at a single tertiary centre

Uday Suma , Avann Charlotte , Barrett Timothy , Dias Renuka , Drummond Lesley , Kershaw Melanie , Krone Ruth

Introduction: Good patient education is the key to successful self-management of diabetes. In October 2013, we introduced a revised and extended ‘Newly Diagnosed Patient Education Programme’ involving 20 structured education sessions delivered by the multidisciplinary team.Aim: To assess the effect of the new patient education programme on HbA1c at the end of two years and compare this to a control group undergoing the old education programme.<...
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ea0045p37 | Diabetes | BSPED2016

The highs and the lows: Glycaemic control and socio-economic factors in paediatric patients with type 1 Diabetes in Blantyre, Malawi

Blackstock Sarah , Kasiya Marrianne , Dube Queen

Background: Type 1 diabetes mellitus (T1DM) is the commonest paediatric endocrine disorder in Malawi. Chronic diseases such as diabetes are frequently neglected in resource limited settings. The life expectancy from diagnosis of T1DM has been reported to be as low as 1 year in parts of Sub-Saharan Africa. The true incidence of T1DM in Malawi is unknown, however diabetic-ketoacidosis (DKA) is thought to be an overlooked child killer due to misdiagnosis. Lack of investigations, ...
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ea0045p38 | Diabetes | BSPED2016

Introduction of an intensive outpatient education programme is acceptable to parents of children, and young people with newly diagnosed type 1 Diabetes

Kershaw Melanie , Krone Ruth , Drummond Lesley , Dias Renuka , Barrett Timothy

Objectives: Many successful European centres provide intensive education as 2 week inpatient admissions for newly diagnosed type 1 diabetes. Prolonged inpatient stay is resource intensive and disrupts the family unit. Our centre aimed to determine the feasibility of delivering an intensive education programme in an ambulatory care setting.Methods: The curriculum, introduced in October 2013, comprised 20 hours face to face education by paediatric diabetes...
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ea0045p39 | Diabetes | BSPED2016

Management of diabetes in a refugee child- the challenges

Madhusudhana Madhavi , Randle Emma , Denial Mark , Wright Neil

Background: Type 1 diabetes is a chronic condition with significant implications on the child, the family and the health services. Management of this condition in a refugee child is fraught with further challenges.Methods: In this observational case report, we discuss the challenges in the management of a 10-year-old Somalian boy, with type 1 diabetes for the past few years, who presented with Diabetic ketoacidosis.Table 1 illustra...
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ea0045p40 | Diabetes | BSPED2016

Abstract unavailable....
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ea0045p41 | Diabetes | BSPED2016

High HBA1c pathway for children and young people with poor glycaemic control: process and outcomes

Fradley Wayne , Sachdev Pooja , Randell Tabitha , Denvir Louise

Background: Children and Young People (C&YP) with poorly controlled diabetes are at increased risk of diabetic ketoacidosis (DKA) and long-term sequelae. There is no clear evidence about how best to manage them. NPDA data highlights that UK numbers are in decline, but still constitutes 21.3% of C&YP with diabetes. The high HbA1c pathway at Nottingham Children’s Hospital (NCH) aims to systematically identify and support C&YP with HbA1c >80 mmol/mol. It prov...
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ea0045p42 | Diabetes | BSPED2016

The seven wonders of diabetes: An audit of the NICE key age specific care processes

Curran Grainne , Abid Noina

Introduction: NICE CG15 (2004) recommends that diabetic patients aged over twelve years receive seven key care processes. The National Paediatric Diabetes Audit (NPDA) aims to improve outcomes and quality of care in paediatric diabetes. The following describes what proportion of children with type 1 diabetes in our Paediatric Diabetes Unit (PDU) are receiving these seven key care processes in comparison to the NPDA (2013–14).Audit Methodology: Patie...
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ea0045p42a | Diabetes | BSPED2016

An audit on the outcomes of care in paediatric diabetes

Curran Grainne , Abid Noina

Introduction: NICE CG15 (2004) states that children with diabetes should receive care to achieve optimum control to reduce risk from diabetes complications. The National Paediatric Diabetes Audit (NPDA) aims to improve outcomes in paediatric diabetes. The following describes the outcomes of care in our Paediatric Diabetes Unit (PDU) in comparison to the NPDA (2013-14).Audit Methodology: Patients aged 1–17 years with a diagnosis of diabetes for &#880...
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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