Paediatric Diabetes Units Research Articles

Frequency of Delayed Puberty among Adolescent Females with Type 1 Diabetes

Abstract Background Female patients with T1DM may display menstrual disturbances, hyperandrogenism or early menopause at certain moments of their lives, thus representing a significant health problem. Objective To detect the frequency of delayed puberty among a cohort of Egyptian adolescent females with type 1 diabetes mellitus (T1DM). Methods This cross sectional study examined 175 adolescent females with T1DM aged(14-18)years following up at the Pediatric and Adolescents Diabetes Unit, Ain Shams University for delayed puberty. History taking with complete physical examination was done including: Tanner staging (delayed puberty was defined as puberty occurring two standard deviations beyond the mean age). Girls were evaluated for delayed puberty in the following situations: (1) no breast development by age 13, (2) no menarche within 3 years of the larche, (3) no menarche by age 14 with signs of hirsutism, (4) no menarche by age 14 with history or examination suggestive of excessive exercise or eating disorder, and (5) no menarche by age 15 (ACOG committee opinion, 2015). Clinical manifestations of insulin resistance, blood pressure and anthropometric measures were assessed with calculation of the z score for age and gender. Laboratory assessment including fasting glucose, HbA1C, fasting lipid profile was done. Results Delayed puberty was found in 6.3 % of the studied adolescent females with T1DM. Mean age at menarche was 13.2 years and the percentage of tanner V was 28 % of this cohort. Mean age was negatively correlated with delayed puberty, while duration of DM, waist circumference Z score, waist/hip ratio Z score and mean of LDL were positively correlated with delayed puberty. No significant relation was found with HbA1C, fasting glucose, cholesterol, triglyceride, HDL Conclusion Although uncommon, delayed puberty can be seen in girls with T1DM. It is correlated to glycemic control and hyperlipidemia.

Diabetes Self-Management Smartphone Application: Patient Satisfaction Survey for Rightest app Using the Short Version User Experience Questionnaire (UEQ-S) : A Single Center Pilot Study

Abstract Background The ability of people with type 1 diabetes mellitus (T1DM) to improve glycemic control depends on their ability to interpret and act on blood glucose results. We investigated applicants satisfaction when switching to blood glucose meters (BGMs) featuring rightest app via Bluetooth using their smartphones. Objective This study aimed to assess the feasibility of the app (rightest) and the participants satisfaction after using the app in 3 months interval by using UEQ -S score. Methods This is an observational study, conducted at the Pediatric and Adolescent Diabetes Unit, Children’s Hospital, Faculty of Medicine, Ain Shams University (PADU), on participants with T1DM(13-18 years old). The recruited participants (n = 20) with T1DM started using the “Rightest” app for 3 months. UEQ-S was used at the end of the study to asses the participants satisfaction. It consists of the two dimensions pragmatic quality (item 1–4) and hedonic quality (item 5–8). Each item is measured on a 7-point Likert scale with two opposite meanings ranging. Results 20 participants with T1DM, following up at PADU, used BGM with rightest app for 3 months. UEQ-S results revealed pragmatic total score (1.425) was above average while the hedonic total score was good(1.250) and the overall score was good(1.338) where -3 indicates extremely bad score while +3 indicates extremely good score. This indicates that they showed overall good satisfaction for mobile app using UEQ-S score. Conclusion This study demonstrated that switching to BGMs with mobile app showed good satisfaction after 3 month interval.

Glycaemic control of children and young people with type 1 diabetes fasting during ramadan at a single london paediatric diabetes unit

Glycaemic control of children and young people with type 1 diabetes fasting during ramadan at a single london paediatric diabetes unit

Glycemic control and study of lipid and bone metabolism in type 1 diabetic children

Introduction. Type 1 diabetes mellitus is considered one of the most common chronic diseases of childhood. It is a high-risk factor for developing early cardiovascular disease and it also affects bone health. Objective. To describe demographic characteristics and biochemical parameters of a population of children with type 1 diabetes, evaluated in the pediatric diabetes unit of a tertiary Spanish hospital. Materials and methods. In this retrospective study, we determined metabolic, lipid, and bone parameters in 124 children with type 1 diabetes who were monitored in the pediatric diabetes unit of the Hospital Universitario Miguel Servet in Zaragoza (Spain) from May 2020 to July 2021. Results. Children with type 1 diabetes have worse metabolic control of the disease at puberty, but their lipid control is considered acceptable. We found an inverse correlation between bone formation markers and disease duration, as well as with metabolic control. Conclusion. Bone formation markers are inversely correlated with the percentage of glycated hemoglobin and diabetes evolution time. Patients’ lipid and bone profiles are more favorable when metabolic control of the disease is achieved.

Leicester Paediatric Diabetes Unit's 'Bridge the Gap' project: Improving access to diabetes technology for children and young people from ethnic minorities and socio-economically deprived families

Leicester Paediatric Diabetes Unit's 'Bridge the Gap' project: Improving access to diabetes technology for children and young people from ethnic minorities and socio-economically deprived families

Vitamin D concentration in type 1 diabetic children. Association with glycemic control, lipidic and bone metabolism

Introduction: vitamin D plays a key role in regulating insulin secretion and its deficit seems to confer an increased risk of developing diabetes mellitus. In this study, we have tried to analyze the prevalence of vitamin D deficiency in our type 1 diabetic children population and if their deficiency is related to a worse control of the disease, as well as with their bone and lipid metabolism. Material and methods: this is a retrospective study, in which both clinical and laboratory data were available for 124 children who were controlled in the Pediatric Diabetes Unit of our Hospital. Results: the median vitamin D concentration of the total sample was 25.41 (7.43) ng/ml, higher in males than in females (p = 0.006); 43.55 % of patients had good metabolic control with glycosylated hemoglobin lower than 7.5 %. Slightly lower glucose and cholesterol concentrations and higher bone alkaline phosphatase concentrations were found when vitamin D concentration was ≥ 20 ng/ml. Conclusions: we have not found any significant differences in relation to metabolic control between children with sufficient and insufficient concentration of vitamin D. The children in the present study presented very similar vitamin D concentrations to those found in a study made in healthy children, and a good metabolic control of their diabetes, with bone and lipid profiles being more favorable when they had good metabolic control.

931-P: Supporting Physical Activity in Children with Type 1 Diabetes: A Survey of Health Care Professionals

Background: The risk of some of the co-morbidities associated with type 1 diabetes (T1D) can be mitigated through physical activity. Despite benefits, research shows that children and adolescents with T1D are not meeting recommended levels of physical activity. Health Care Professionals (HCPs) have an important role in supporting and encouraging children and adolescents to be physically active. Therefore it is important to understand the perspectives of HCPs in relation to understanding physical activity behaviours in children and adolescents, prior to designing interventions to support physical activity. Methods: An online mixed methods survey of HCPs in England and Wales. Respondents were asked questions about how they support physical activity in the clinic and their perceptions of barriers/enablers of physical activity. Quantitative data were analysed descriptively, qualitative data were analysed using a combined deductive framework and inductive thematic analysis using the Capability, Opportunity, Motivation model of behaviour (COM-B). Results: Responses were received from 114 individual HCPs, representing 45% of paediatric diabetes units in England and Wales. Results show that HCPs felt that the promotion of physical activity is important in their clinic (90%) and advise children and adolescents to increase levels of physical activity (88%). Many respondents (43%) felt there was lack of education opportunities for HCPs on this topic. Qualitative responses highlighted three key areas of behaviour that might be a barrier to physical activity in their patients: (1) psychological capacity (i.e., fear of hypoglycaemia and lack of understanding of how to manage insulin and glucose levels), (2) physical opportunity (i.e., time, cost, and access to resources), and (3) social opportunity (i.e., family, school, and peer support). Conclusion: This understanding will help develop future interventions to support physical activity in children and adolescents with T1D. Disclosure E. Cockcroft: None. P. Narendran: Speaker’s Bureau; Self; Novo Nordisk Inc., Sanofi. E. Wooding: None. R. C. Andrews: None. Funding National Institute for Health Research Applied Research Collaboration South West Peninsula (to E.C.)

Impact on the well-being perceived by caregivers of children and adolescents with type 1 diabetes following the use of interstitial glucose measurement systems

IntroductionType 1 diabetes mellitus (DM-1) is one of the most common chronic childhood diseases, and it is essential to optimize glycemic control in order to avoid complications. For years, interstitial glucose measurement systems (MGI systems) have been among the new technologies at the forefront of self-care. ObjectivesTo determine the impact on the well-being of the caregivers of patients with DM-1 under 18 years of age, controlled at a Pediatric Diabetes Unit of a third level hospital, of the use of MGI systems. Material and methodsThis was an observational, descriptive and analytical cohort study based on a questionnaire completed by the patients’ caregivers, as well as from the patient's clinical history. ResultsThere were 120 participants (55.5% males), with a mean age 13.20 +/- 3.71 years and mean glycosylated haemoglobin (HbA1c) 7.36% +/- 0.90. 52.5% of the sample used MGI systems. The caregivers of patients using MGI systems showed significantly higher scores (p < 0.05) regarding well-being, compared to the caregivers of patients not using this technology. In the former, a significant improvement (p < 0.05) in these variables with respect to the values prior to the beginning of their use was observed. ConclusionsThe use of MGI systems for diabetes self-management in our study led to a greater sense of well-being on the part of caregivers compared with before their introduction, as well as in comparison with those who continued to perform measurements using daily capillary glycemias.

Impacto en el bienestar percibido por cuidadores de niños y adolescentes con diabetes tipo 1 mediante la utilización de sistemas de medición de glucosa intersticial

IntroductionType 1 diabetes mellitus (DM-1) is one of the most common chronic childhood diseases, and it is essential to optimize glycemic control in order to avoid complications. For years, interstitial glucose measurement systems (MGI systems) have been among the new technologies at the forefront of self-care. ObjectivesTo determine the impact on the well-being of the caregivers of patients with type 1 diabetes mellitus under 18 years of age, controlled at a Pediatric Diabetes Unit of a third level hospital, of the use of MGI systems. Material and methodsThis was an observational, descriptive and analytical cohort study based on a questionnaire completed by the patients’ caregivers, as well as from the patient's clinical history. ResultsThere were 120 participants (55.5% males), with a mean age 13.20+/-3.71 years and mean glycosylated haemoglobin (HbA1c) 7.36%+/-0.90. 52.5% of the sample used MGI systems. The caregivers of patients using MGI systems showed significantly higher scores (p<.05) regarding well-being, compared to the caregivers of patients not using this technology. In the former, a significant improvement (p<.05) in these variables with respect to the values prior to the beginning of their use was observed. ConclusionsThe use of MGI systems for diabetes self-management in our study led to a greater sense of well-being on the part of caregivers compared with before their introduction, as well as in comparison with those who continued to perform measurements using daily capillary glycemias.

Technology, telemedicine and social media are tools to improve health outcomes, education and patient engagement in a paediatric diabetes service

AbstractFew centres in the UK within adult and paediatric diabetes units adopt digital technology, telemedicine or social media within their services. Perhaps this is due to both lack of investments and to some extent clinical leadership to champion and drive change.The 2018 Mary MacKinnon Diabetes UK lecture is aimed at showing how health outcomes, education and patient engagement can be significantly improved using novel digital and technology strategies as effective means of driving change and delivering good quality of care within a paediatric diabetes service. Copyright © 2018 John Wiley &amp; Sons.

OP.5C.05] SERUM URIC ACID IS INCREASED IN NORMOTENSIVE OBESE CHILDREN WITH A PARENTAL HYSTORY OF HYPERTENSION

Objective: Increased uric acid levels are closely associated with new-onset hypertension in children, and pilot studies showed that pharmacological lowering of uric acid may reduce blood pressure (BP) in obese pediatric patients. Nevertheless, controversy remains concerning a direct causative role of serum uric acid (SUA) in the pathogenesis of essential hypertension (EH). Our study was aimed to determine if normotensive obese children and adolescent offspring of adults with EH show SUA levels different than those of pediatric subjects in whom there is non family history of EH. Design and method: Fifty-nine obese normotensive children and adolescents, attending for metabolic assessment the Pediatric Diabetes Unit, Children's Hospital “G. Di Cristina”, and for cardiovascular evaluation the ESH Hypertension excellence center of the University of Palermo, were studied. All the subjects, aged between 8 and 17 years, underwent routine blood chemistry and oral glucose tolerance test with glucose and insulin determinations. All subjects had blood pressure determinations below the 90th percentile and had no previous history of elevated blood pressure. Results: There were 14 subjects whose parents were both normotensive (FH—), and the remaining 45 subjects whose one or both parents were hypertensive. FH + did not differ regarding age, sex distribution, blood pressure values, body mass index, waist circumference, serum glucose levels when compared to FH-. Among the metabolic parameters assessed, only SUA was significantly higher in FH+ than in FH - (p = 0.007; figure 1).This difference held after adjusting for age, gender and BMI (p = 0.01). Conclusions: Our results, showing higher values of SUA in normotensive obese children and adolescents with parental history of EH, seem to support the hypothesis that increased uric acid may precede and determine the development of hypertension.

Self-care management of type 1 diabetes has improved in Swedish schools according to children and adolescents.

Age-appropriate support for diabetes self-care is essential during school time, and we investigated the perceived quality of support children and adolescents received in 2015 and 2008. This national study was based on questionnaires answered by children and adolescents aged 6-15 years of age with type 1 diabetes attending schools or preschools in 2008 (n = 317) and 2015 (n = 570) and separate parental questionnaires. The subjects were recruited by Swedish paediatric diabetes units, with 41/44 taking part in 2008 and 41/42 in 2015. Fewer participants said they were treated differently in school because of their diabetes in 2015 than 2008. The opportunity to perform insulin boluses and glucose monitoring in privacy increased (80% versus 88%; p < 0.05). Most (83%) adolescents aged 13-15 years were satisfied with the support they received, but levels were lower in girls (p < 0.05). More subjects had hypoglycaemia during school hours (84% versus 70%, p < 0.001), but hypoglycaemia support did not increase and was lower for adolescents than younger children (p < 0.001). Children and adolescents received more support for type 1 diabetes in Swedish schools in 2015 than 2008, but more support is needed by girls and during hypoglycaemia.

Achievement of metabolic control among children and adolescents with type 1 diabetes in Spain

To assess metabolic control in a paediatric T1D population in Spain and analyse the rate of severe acute decompensations and chronic complications. Data from patients treated at eight paediatric diabetes units with experienced diabetes teams between June and December 2014 were analysed in an observational prospective study. Variables included: age, sex, diabetes duration, number of follow-up visits/year, anthropometrical data, insulin treatment modalities, mean annual HbA1c and the prevalence of acute and chronic complications. SPSS statistics 21.0 was used. A total of 853 patients (49.7% female) with a mean age of 12.1 ± 3.7 years were included. Anthropometric data were normal. Mean diabetes duration was 8 ± 3.4 years. Mean outpatient follow-up was 4.7 ± 0.04 visits/year. Twenty-five per cent were on continuous subcutaneous insulin infusion (CSII). Mean HbA1c was 7.3 ± 1% (56 ± 8 mmol/mol) and 66.6% had HbA1c < 7.5% (58 mmol/mol). HbA1c value correlated negatively with age at onset and positively with years of diabetes, number of visits/year and current age (F = 7.06; p = 0.01). Patients on CSII (n = 213) were younger, attended the outpatient clinic more frequently, were diagnosed earlier, had better metabolic control and had presented more severe hypoglycaemic episodes the previous year. The rate of severe decompensation (episodes/100 patients/year) was ketoacidosis 1.5 and severe hypoglycaemia 4.5. The prevalence of chronic complications was very low. Our data describe the good compliance of paediatric T1D patients treated at eight paediatric units in Spain following international standards of metabolic control.

Effect of instructions on selected self-care practices among type-1 diabetic children

Background Type 1 diabetes (T1D), which tends to develop in childhood, needs certain self-care practices to achieve optimal glycemic control. Aim The study aimed to evaluate the effect of instructions on selected self-care practices among T1D children. Patients and methods A quasi-experimental one-group design with pre–post assessment was used in this study, which was carried out in the Pediatric Diabetes and Endocrine Unit at El Monira University Pediatric Hospital, on a purposive sample of 100 diabetic children. The data were collected using a structured interview questionnaire and four observational checklists for self-care practices of insulin injection by syringe and by pen, blood glucose test, and foot care. Results Children’s age ranged between 6 and 14 years, with female predominance. Their readiness for self-care was high, especially for insulin injection, and none of the children had adequate performance of any of the procedures before the intervention. At the postintervention phase, there were statistically significant improvements in all procedures, reaching 76% for insulin injection by syringe, 82 for injection by pen, 77% for blood glucose testing, and 58% for feet care (P Conclusion The study concluded that children’s practice scores of self-care activities improved significantly after the intervention, and readiness of children plays an active role in improving these scores. The participation of parents, particularly with very young children, and more emphasis on foot care are needed. The study recommends that the intervention should be implemented in settings providing care to children with T1D. Feet care for children with T1D was done by parents until the children realize the importance of caring and examining their feet periodically. The impact of the program on glycemic control needs further research.

Management of children with type 1 diabetes during illness: a national survey

AimAdequate sick-day management at home can reduce the risk of progression to diabetic ketoacidosis and admission to hospital. The aim of this project was to review the management of diabetes...

Dietary Intake of Children with Type 1 Diabetes in Bahrain: A Case-Control Study

Background &amp; Objectives: Bahrain is reported to rank amongst the top 10 countries for diabetes prevalence worldwide. In particular, growing numbers of children are being diagnosed with Type 1 diabetes mellitus (T1DM).The objective of this study was to describe the dietary intake of Bahraini children with T1DM as compared to a sample of healthy counterparts and to determine whether the nutrient intakes of Bahraini children with T1DM meet the current recommendations. Design &amp; Setting: This was a case-control study. Dietary intake, estimated using a24-hour dietary recall, for the cases was gathered from the Pediatric Endocrine and Diabetes Unit at the Salmaniya Medical Complex and compared to the 24-hour recalls of children without diabetes recruited from Local Health Centers. Patients &amp; Methods: 50 children aged 6-12 years receiving a confirmed diagnosis of T1DM in the years 2009 and 2010 compared with 55 healthy comparators. Results: Children with T1DM consumed significantly more calories than controls (p&lt;0.001) and significantly more protein relative to their RDA (p&lt;0.029). Both groups failed to meet the RDA values for dietary fiber and for Vitamin D. Sodium intakes were in excess of RDA values although no significant difference was observed between groups (p=0.403). Conclusion: The diets of both children with and without T1DM were found to contain excess protein and sodium and inadequate fiber, vitamin D and calcium. Children with T1DM also appeared to consume excess energy and fat. There is a need to endorse existing dietary guidelines for children with T1DM.

What young people want from their diabetes team: developing a patient reported experience measure (PREM) for young people with type 1 diabetes

AbstractThe objectives of this study were: to explore whether a patient reported experience measure (PREM) questionnaire for carers reflected aspects of the clinic experience important to young people; and to develop a PREM for young people with type 1 diabetes (T1D) to measure their clinic experience.A cross‐sectional study design and focus groups were used. Questions from a PREM for carers and four open‐ended questions were incorporated into a semi‐structured interview administered to 77 young people with T1D across four paediatric diabetes clinics.Eighty‐two percent of young people rated help in managing high and low blood glucose as the most important aspect of their clinic experience. All items identified by parents as important were rated important by over two‐thirds of young people, with the exception of ‘How important is it to be seen on your own?’ (40% rated this as important). Thematic analysis identified two superordinate themes: learning new information, and age appropriate structure and communication. Exemplary quotations from each theme were converted into questions and reviewed by six young people using cognitive interviewing. The final question set was reviewed by the National Paediatric Diabetes Audit PREM working group. The PREM was distributed to 177 paediatric diabetes units in England and Wales for completion between September 2012 and January 2013.Exploring what is important for a young person about their clinic experience has supported the construction of a paediatric‐centred measure. The young person PREM creates opportunities for improvement in care to help diabetes teams listen to patients and work with them to provide the best possible service. Copyright © 2015 John Wiley &amp; Sons.

G474 Variation in patient experience across paediatric diabetes units (pdus) in england and wales and association with glycaemic outcomes

Background/Aims Patient Reported Experience Measures (PREMs) are increasingly recognised as an important indicator of healthcare quality. We investigated variation in patient experience across Paediatric Diabetes Units (PDUs) in England and Wales and explored links between PREMs and glycaemic outcomes. Methods An aggregate analysis of linked PREM and glycaemic data for each PDU collected as part of the 2012–2013 National Paediatric Diabetes Audit (NPDA) was conducted. The percentage of patients/carers who reported a high level of satisfaction (scores 9 or 10/10) in the friends and family recommendation test was used as a quality indicator of diabetes care. A funnel plot of the above indicator was constructed and the 95% and 99.8% control limits around the mean were used to distinguish between common–cause (units lying within the control limits) and special-cause variation (units lying outside the control limits). A linear regression model was also fitted for the relationship between mean satisfaction score and mean HbA 1c at PDU level. Results Percentage of patients who reported high satisfaction showed a 2.9-fold variation (range 35% to 100%) across PDUs with 60/170 (35.3%) and 33/170 (19.4%) units falling outside the 95% and the 99.8% control limits respectively. Of the 170 PDUs, 21 (12.4%) lay below the lower 99.8% control limit (Figure 1). Linear regression showed a significant negative association between mean HbA 1c (mmol/mol) and average satisfaction score for each PDU (regression coefficient= –2.9, 95% CI: –4.7 to –1.1, p = 0.002) (Figure 2). Conclusion Patient satisfaction varied considerably across PDUs with one in three units exhibiting more variation than expected by chance. At aggregate level, clinics with higher mean satisfaction had better average glycaemic control. Individual-level analyses allowing for nested sources of variation (patients within clinics) are needed to confirm these clinic-level analyses. Further work should also adjust for “case-mix variation” i.e. correct for differences in the sociodemographic and disease profile of children served by different clinics.

Clinical spectrum and outcome of invasive filamentous fungal infections in children with Type 1 diabetes: North Indian experience.

There is scarcity of data on spectrum and outcome of invasive filamentous fungal infections (IFIs) in children with Type 1 diabetes (T1D) from developing countries. A retrospective review of medical records of children with T1D hospitalized with IFI over the past decade at the Pediatric Endocrinology and Diabetes Unit of a large tertiary care hospital of North India was performed with an aim to study their clinical spectrum, hospital course and final outcome. Of the 10 patients studied, nasal/paranasal involvement was seen in 6 and pulmonary involvement in 5 patients. One patient developed disseminated disease. Majority of the identified mycoses belonged to Class Zygomycetes Order Mucorales. Early surgery along with antifungal therapy helped limit the extension of infection and achieve a good outcome in majority of patients. Two patients died; one with a late diagnosis of pulmonary mucormycosis and the other with disseminated disease. The longterm morbidity in the survivors was minimal. In conclusion, rapid diagnosis followed by a multimodal approach involving aggressive surgical debridement, appropriate antifungal therapy and control of hyperglycemic state is the key to good outcome in this otherwise lethal infection.

Exploring variation in treatment targets across paediatric diabetes units in England and Wales

Exploring variation in treatment targets across paediatric diabetes units in England and Wales