Retrospective comparison of laboratory based versus point-of-care haemoglobin A1c testing

The aim of this study was to look at the precision and accuracy of Point of Care glycosylated haemoglobin (POC-HbA1c) compared with laboratory-measured HbA1c (Lab-HbA1c). Methods Retrospective analysis of the charts of patients attended paediatric diabetes outpatient clinics during January 2018 to July 2019 in University Hospital Limerick (UHL) was conducted. Results In total, 163 patients’ charts were analysed, including 79 females (48.5%) and 84 males 51.5%). Lab HbA1c data were skewed positively, with a median of 67mmol/mol (IQR (60 to 76). POC- HbA1c data were also positively skewed, median of 61mmol/mol (IQR (55 to 68). The differences between POC HbA1c and Lab-HbA1c was skewed negatively, median of -6mmol/mol (IQR (-9, -2). Gender, age and month of testing did not affect results.POC-HbA1c was more reliable and accurate when tested within 14 days of Lab-HbA1c.Conclusion POC-HbA1c was comparatively lowered as compared with Lab- HbA1c. The results for POC- HbA1c is most reliable compared with Lab-HbA1c if tested within14 days

Play, art, music and exercise therapy impact on children with diabetes

Diabetes mellitus (DM) is a global public health issue. Type 1 diabetes (T1D) is the predominant diabetes type in children and always requires insulin therapy. The incidence rate of newly diagnosed T1D in children continues to increase in Ireland Roche et al. (Eur J Pediatr 175(12):1913-1919, 2016) and worldwide Patterson et al. (Diabetologia 62(3):408-417, 2019). The objective of this study was to conduct a literature review of the efects of various non-pharmacological therapeutic modalities on the control of diabetes in children. A literature review was performed using PubMed, Medline, Embase and Cochrane library to evaluate play, art, music and exercise therapy in the treatment of DM using the keywords: “paediatric”, “diabetes”, “play therapy”, “art therapy”, “music therapy” and “exercise therapy”. These search terms initially returned 270 cases, which resulted in a total of 11 papers being reviewed after eliminating duplicate or irrelevant papers. Literature review showed that all therapies have a positive impact on the child, but there is limited research looking at the impact of therapy on quantitative measures such as HbA1c or ‘time in range’

Parent and child perceptions of physical activity with type 1 diabetes

Introduction Type 1 diabetes (T1D) is a lifelong illness that affects over 2500 children in Ireland. Management involves complex daily regimens including frequent blood glucose monitoring, pharmacotherapy, dietary management, and physical activity (PA). PA is an important modifiable lifestyle factor. Unfortunately, children with T1D remain physically inactive. Children with T1D face disease-specific barriers and facilitators to PA engagement. All aspects of T1D management for children are supported or supervised by parents. Thus, the purpose of this study was to examine parents’ and children’s perceptions of barriers and facilitators to PA engagement. Research design and methods 43 parent and child dyads participated. Parents completed a self-report survey. Children completed a modified version of the Physical Activity Questionnaire for Children (PAQ-C) that explored habitual PA patterns, perceived facilitators and barriers to PA engagement. Results 21 females, 22 males and their parents (36 mothers, 7 fathers) participated. 69% of males and 90% of females reported that having diabetes did affect their PA participation. 54% of males and 48% of females were insufficiently active based on their total PAQ-C score ( Conclusions This study demonstrates the potential influence of parents’ perceptions on PA engagement in children with T1D. Additional education is needed to support the promotion of PA for children with T1D. </p

Physical activity surveillance in adolescents with type 1 diabetes: A pilot mixed-methods investigation

Type 1 diabetes (T1D) affects over 2,500 children in Ireland. Insulin replacement is the mainstay of treatment for T1D, and physical activity (PA) is an important, modifiable lifestyle factor for sustaining health. Surveillance of PA for both research and clinical purposes in paediatric T1D has been limited. This study deployed both quantitative (accelerometry) and qualitative (self-report) measures to assess habitual PA patterns in children with T1D. Twenty-one participants (9 females, 12 males) between 10 and 17 years (mean 13:7±1:94 years) were recruited from an Outpatients Paediatric Diabetes Clinic. Total steps, standing time (minutes (mins)) and sitting time (mins) were recorded using the activPAL 3 microactivity monitor. Clinical parameters (HbA1c, insulin regimen, and weight centiles) were measured. A self-report diary was used to measure perceived activity levels. The findings of this study show that participant children with T1D are not achieving the required steps per day to sustain physical health (recommended minimum 11,500). Females (mean = 7,306 steps ± 5,468) achieved significantly less (p = 0:001) steps per day compared to males (10,806 steps ± 5,904). No significant differences were found between genders for sitting time or standing time. Overweight or obesity was identified in 44% of female participants and 15% of male participants. Mean HbA1c for both females 8.25% (67 mmol/mol) and males 7.97% (64 mmol/mol) was above the International Society for Pediatric and Adolescent Diabetes (ISPAD) recommended <7.0% (53 mmol/mol) for children. Further research is warranted to investigate PA promotion strategies in populations of children with paediatric T1D

Pregnancy outcomes in women with onset of type 1 diabetes mellitus less than 18 years

Background Pregnancy in women with type 1 diabetes mellitus (T1DM) is associated with an increased risk of congenital malformations, obstetric complications and neonatal morbidity. This study aims to investigate maternal, perinatal and neonatal outcomes of pregnancies in women with onset of T1DM less than 18 years of age. Methods This retrospective cohort study extracted data regarding prenatal, intrapartum and postnatal outcomes of pregnancies in women with onset of T1DM<18 years identified from the diabetes in pregnancy register at University Maternity Hospital Limerick, treated from July 1, 2007 to July 1, 2017. Results Seventeen women with onset of T1DM <18 years gave birth to 23 live infants during the period studied. 73.9% of pregnancies were unplanned. Only 21.7% of pregnancies took preconceptual folic acid. 60.9% of infants required treatment for hypoglycemia. Conclusion The high prevalence of unplanned pregnancy and poor uptake of prepregnancy care must be improved on in order to improve outcomes for this high-risk group

Exploring the attitudes and experiences of adolescents with type 1 diabetes towards transition of care

Introduction Transition from adolescence to adult care is very challenging for most patients. Without appropriate appointments and education, adolescents can get lost to follow up within one-year of transitioning to adult care (Mistry et al. Diabet Med 32(7):881–885, 2015). Loss to follow-up can increase risks of adverse short and long term diabetes-related complications, with healthcare contacts mainly limited to crisis-based management (Iversen et al. Scand J Caring Sci 33(3):723–730, 2019). Aims The purpose of this study was to evaluate the patient’s perspective of the process of transition from paediatric to adult-based diabetes services in the Mid-West Region of Ireland. Methods We implemented a new transition clinic at University Hospital Limerick with the collaboration of paediatric and adult endocrinology teams. Eighteen patients opted to attend the clinic, but only 17 patients consented to participate in a qualitative assessment study and completed questionnaires before and after the transition clinic. Results and conclusion In terms of medical management, patients had a good understanding of hypoglycaemia and insulin dose adjustment principles, but were least comfortable with carbohydrate counting. Patients self-ranked their knowledge on driving and sexual health with a diagnosis of diabetes as poor, in comparison to understanding effects of alcohol and smoking on diabetes. Overall, a majority of the respondents felt more confident in moving to adult-care after attending the transition clinic

Low prevalence of SARS-CoV-2 detected in symptomatic children admitted to hospital

Aims Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) originated in Wuhan, China in 2019 and is responsible for the condition known as COVID-19. COVID-19 was first reported in Ireland in February 2020 with University Hospital Limerick’s (UHL) first paediatric case reported on 4th March 2020. Studies have shown clinical manifestations of children’s cases are generally less severe than those of adults. UHL serves a catchment population of approximately 100,000 children. We aimed to describe the clinical presentation, and prevalence of SARS-CoV-2, in children requiring inpatient hospitalization during the initial phase of the pandemic in Ireland. Methods Data were examined relating to all inpatients aged 0 – 16 years admitted with a queried or confirmed diagnosis of COVID-19 from 8 th February 2020 to 8th June 2020. Emergency Department notes and inpatient records along with laboratory and radiology records were reviewed. Results 220 paediatric inpatients were tested by PCR for SARS-CoV-2 during this period; 101 (45.9%) were female. Ninety-five (43.2%) were diagnosed with ‘viral illnesses’. Seven (3.2%) had laboratory confirmed SARS-CoV-2, with an average age of 8.1 years (range: 0.59 years to 13.77 years). There were two Kawasaki-like illnesses admitted; both tested negative for SARS-CoV-2 on PCR. In our SARS-CoV-2 positive cohort, there was no associated significant morbidity and no associated mortality. Conclusion During the initial phase of the COVID-19 pandemic, prevalence of confirmed SARS-CoV-2 in symptomatic hospitalised children was low at 3.2

Irish Paediatric Critical Care Audit National Report 2017-2019

The Paediatric Intensive Care Audit Network (PICANet) collects information on all patients admitted to paediatric critical care units in the United Kingdom (UK) and the Republic of Ireland (ROI). The objective of this data collection is to measure the quality of care in Paediatric Critical Care Units (PCCUs) and benchmark this against other PCCUs across the UK. Since 2009, reports for the ROI have been produced within PICANet UK in conjunction with the ROI PCCU clinical leads. In 2015, the audit of paediatric critical care was incorporated into the National Office of Clinical Audit (NOCA), which provides support through a clinical audit team and an independent voluntary governance structure.</p