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There is debate about the rationale and the most cost-effective strategy for screening adults for type 2 diabetes and a paucity of literature on the subject in children. Although tests exist to detect undiagnosed type 2 diabetes, these... more
There is debate about the rationale and the most cost-effective strategy for screening adults for type 2 diabetes and a paucity of literature on the subject in children. Although tests exist to detect undiagnosed type 2 diabetes, these tests have not been extensively studied in this age group, and the outcomes of additional years of treatment in these screening-detected individuals are currently unknown. Despite this, the American Diabetes Association (ADA) recommends opportunistic screening of at-risk children. The true prevalence of childhood type 2 diabetes is unknown in many countries and the natural history of the condition has not been fully delineated in this age group. This review evaluates the rationale for screening asymptomatic children and adolescents for type 2 diabetes using modified World Health Organisation (WHO) criteria. Br J Diabetes Vasc Dis 2008; 8: 163—168
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Type 1 diabetes is a self-managed condition. Regular monitoring of blood glucose (BG) levels has been the cornerstone of diabetes management. Finger prick BG testing traditionally has been the standard method employed. More recently,... more
Type 1 diabetes is a self-managed condition. Regular monitoring of blood glucose (BG) levels has been the cornerstone of diabetes management. Finger prick BG testing traditionally has been the standard method employed. More recently, rapid advancements in the development of continuous glucose monitoring devices have led to increased use of technology to help children and young people with diabetes manage their condition. These devices have the potential to improve diabetes control and reduce hypoglycaemia especially if used in conjunction with a pump to automate insulin delivery. This paper aims to provide an update on main CGM devices available and practical considerations for doctors if they come across a child with diabetes who is using one of these devices.
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Research suggests a role for cannabidiol oil in managing certain forms of paediatric onset epilepsy. However, studies on the impact of cannabis on the hypothalamo-pituitary-gonadal (HPG) axis have conflicting results.... more
Research suggests a role for cannabidiol oil in managing certain forms of paediatric onset epilepsy. However, studies on the impact of cannabis on the hypothalamo-pituitary-gonadal (HPG) axis have conflicting results. Delta-9-tetrahydrocannabinol (Δ9-THC) acutely inhibits gonadotropin-releasing hormone in the hypothalamus, reducing testosterone levels by 65% in rhesus monkeys. Additionally, there have been reports of pubertal arrest and delayed puberty in male cannabis users. In contrast, other studies have reported higher testosterone levels following long-term cannabis use. A 2-year-old boy presented with testicular enlargement, increased penile length and growth of coarse pubic hair developing over 6 months. His mother procured cannabidiol oil online, which he started taking 7 months earlier for severe epilepsy refractory to medical management. Subsequent investigations confirmed central precocious puberty. While it is unclear whether the precocious puberty is a direct consequenc...
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In the UK, there have been reports of significant reductions in paediatric emergency attendances and visits to the general practitioners due to COVID-19. A national survey undertaken by the UK Association of Children’s Diabetes Clinicians... more
In the UK, there have been reports of significant reductions in paediatric emergency attendances and visits to the general practitioners due to COVID-19. A national survey undertaken by the UK Association of Children’s Diabetes Clinicians found that the proportion of new-onset type 1 diabetes (T1D) presenting with diabetes ketoacidosis (DKA) during this COVID-19 pandemic was higher than previously reported, and there has been an increase in presentation of severe DKA at diagnosis in children and young people under the age of 18 years. Delayed presentations of T1D have been documented in up 20% of units with reasons for delayed presentation ranging from fear of contracting COVID-19 to an inability to contact or access a medical provider for timely evaluation. Public health awareness and diabetes education should be disseminated to healthcare providers on the timeliness of referrals of children with T1D.
Medium chain acyl-CoA dehydrogenase deficiency (MCADD) is an autosomal recessive fatty acid β-oxidation defect. The enzyme, medium chain acyl-CoA dehydrogenase is important in the breakdown of medium chain fats into acetyl-CoA to produce... more
Medium chain acyl-CoA dehydrogenase deficiency (MCADD) is an autosomal recessive fatty acid β-oxidation defect. The enzyme, medium chain acyl-CoA dehydrogenase is important in the breakdown of medium chain fats into acetyl-CoA to produce ketones. Ketones are used as an alternative energy source when glucose or hepatic glycogen stores become depleted during prolonged fasting. In MCADD during periods of fasting or acute illness, there are insufficient ketones to compensate for the glucose energy deficit, resulting in an hypoketotic hypoglycaemia alongside a build-up of fatty acids. This build-up of fatty acids can be neurotoxic and lead to altered brain function and even unexpected death. Management includes avoiding prolonged periods of starvation, consuming high carbohydrate drinks during periods of illness and in symptomatic patients, reversal of catabolism and sustained anabolism by provision of simple carbohydrates by mouth or intravenously. Coexistence of MCADD and type 1 diabet...
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Pseudohypoaldosteronism (PHA) due to obstructive uropathy, urinary tract infections and congenital urogenital malformations has been reported in the literature; however, there are no reports of PHA associated with hydrometrocolpos due to... more
Pseudohypoaldosteronism (PHA) due to obstructive uropathy, urinary tract infections and congenital urogenital malformations has been reported in the literature; however, there are no reports of PHA associated with hydrometrocolpos due to a common urogenital tract. Hydrometrocolpos is a condition resulting in distension of the vagina and uterus due to accumulation of secretions (other than blood), caused by increased oestrogenic stimulation and vaginal outflow obstruction. We report on a neonatal case of PHA caused by recurrent hydrometrocolpos presenting with vomiting and poor weight gain. There was significant hyponatraemia, hyperkalaemia, and anaemia requiring medical stabilisation prior to surgery. The mechanism by which PHA occurs in obstruction involves renal tubular dysfunction due to pressure from hydronephrosis and the release of intrarenal cytokines. In addition, there is an immature or resistant renal tubular responsiveness to aldosterone during infancy. Clinicians should ...
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There are no locally derived growth charts in Nigeria, and so, health workers rely on international reference charts. We therefore compared the growth characteristics of 4350 school-age Nigerian children (SNC) (2243 girls, 2107 boys)... more
There are no locally derived growth charts in Nigeria, and so, health workers rely on international reference charts. We therefore compared the growth characteristics of 4350 school-age Nigerian children (SNC) (2243 girls, 2107 boys) (4-16 years) from three ethnic groups (Hausa, Igbo and Yoruba) to both the UK (UK 1990) and US (2000 CDC) reference data. Height of SNC was similar to international references at the start of school age and then started to decline. The decline appeared to peak at 15 years for boys and 13 years for girls. At all ages, sex, ethnicity and affluence, SNC were lighter than international references. There were significant differences in the prevalence of stunting, underweight and obesity among the three ethnic groups (p < 0.05). There is a risk of over-diagnosing short stature and underweight if health workers continue to use growth charts derived from other geographical areas.
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Diabetes mellitus is associated with a range of dermatologic presentations, including granuloma annulare and necrobiosis lipoidica diabeticorum. Granuloma annulare occurs earlier than necrobiosis lipoidica diabeticorum and the association... more
Diabetes mellitus is associated with a range of dermatologic presentations, including granuloma annulare and necrobiosis lipoidica diabeticorum. Granuloma annulare occurs earlier than necrobiosis lipoidica diabeticorum and the association with diabetes mellitus is much weaker. We describe two children with diabetes who both developed granuloma annulare and later, necrobiosis lipoidica diabeticorum. We postulate that the early onset and transient nature of granuloma annulare, compared with the later onset and persistence of necrobiosis lipoidica diabeticorum, might account for the different apparent rates of association with diabetes mellitus.
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The diagnostic value of tests used in assessing hypothalamic-pituitary-adrenal axis (HPA) in children remains controversial. A systematic review and meta-analysis with receiver-operated-characteristic curve was undertaken to assess the... more
The diagnostic value of tests used in assessing hypothalamic-pituitary-adrenal axis (HPA) in children remains controversial. A systematic review and meta-analysis with receiver-operated-characteristic curve was undertaken to assess the diagnostic values of conventional standard dose 250 μg tetracosactrin (ACTH), short Synacthen test (SSST) and/or low-dose Synacthen test (LDSST) in the assessment of HPA insufficiency in children. Studies eligible for inclusion were any study that compared the use of the LDSST and/or SSST in the assessment of central adrenal insufficiency in children compared with reference standard test. There were no randomised trials found. SSST resulted in higher specificity and positive likelihood ratio than LDSST. The LDSST had a higher sensitivity (86% vs 61%) but a lower specificity (88% vs 99%) than the SSST, but there was high heterogeneity from the LDSST studies with various doses of Synacthen used. Lack of standardisation of assays and protocols with regar...
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Type 1 diabetes (T1D) is characterised by autoimmune destruction of pancreatic β cells leading to insulin deficiency. Prompt referral to a specialist paediatric diabetes team (PDT) for insulin initiation and further management is... more
Type 1 diabetes (T1D) is characterised by autoimmune destruction of pancreatic β cells leading to insulin deficiency. Prompt referral to a specialist paediatric diabetes team (PDT) for insulin initiation and further management is important to prevent diabetic ketoacidosis (DKA), which remains the most common cause of death in this condition. The aim was to study the timeliness of referrals from general practitioners (GPs) to PDT, of children suspected of having TID. We carried out a survey of the practice of GPs when they suspect TID in a young person, to investigate whether they recognised the need for urgent referral to PDT. In addition, we carried out retrospective case notes review of children diagnosed with diabetes mellitus between January 2005 and December 2014. 111/300 (37%) of GPs replied to survey. Of these, 73/111 (65.8%) would have referred promptly to the PDT in accordance with National Guidelines. However, 34.2% would have taken an action that would have led to delay i...
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Surgery can carry extra risks for people with diabetes but these risks can be reduced by following clear guidelines. Surgery and general anaesthesia cause a complex neuroendocrine stress response that can lead to hyperglycaemia and... more
Surgery can carry extra risks for people with diabetes but these risks can be reduced by following clear guidelines. Surgery and general anaesthesia cause a complex neuroendocrine stress response that can lead to hyperglycaemia and contribute to increased morbidity in patients with diabetes. To reduce the risk of such adverse outcomes, children and young people undergoing surgery need to have their fluid and insulin therapy carefully managed, ensuring there is optimal hydration while avoiding hyperglycaemia or hypoglycaemia. Written guidelines with algorithms and a systematic approach to glycaemic management will help reduce errors in management and ensure a consistent approach to care. Guidelines have been produced by the Association of Children’s Diabetes Clinicians to help guide healthcare professionals when caring for a young person with diabetes who needs surgery, and this article presents some of its main points.
Review of patients' notes while investigating clinical incidents showed a recurring problem of poor documentation of important aspects of the paediatric post-take ward round. To evaluate the impact of an acrostic (type of mnemonic),... more
Review of patients' notes while investigating clinical incidents showed a recurring problem of poor documentation of important aspects of the paediatric post-take ward round. To evaluate the impact of an acrostic (type of mnemonic), created to reflect the aspects of care that should be documented after every ward round, on the completeness of note keeping. The acrostic, 'Please Verify Information For Doctors, Please Note Every Plan, was developed in 2010 to make it easy to remember the important aspects of post-take ward round, which are: Problem; Vital signs; Investigations; Fluids; Drugs; Patient/Parental concerns; Nursing concerns; Examination; Plan. The acrostic was introduced to doctors at a teaching session and included in the mandatory induction programme for all new doctors. Impact of use of the acrostic was evaluated in 2011 by audit of case notes before and after its introduction, with re-audit 2 years later. A survey of junior doctors on their attitude to its use ...