Idiopathic short stature is a common reason for referral to the general paediatric or endocrine clinic. It can negatively impact the quality of life for the child and young person, extending into ...adulthood for some. However, these children are healthy individuals and treatment is not usually indicated. Whilst those with constitutional delay in growth and puberty can be given hormonal supplementation to induce puberty, there is no treatment available in the UK for the remaining children and young people as growth hormone is not approved for idiopathic short stature. It is important to emphasise to the child, young person and family that they are following a normal pattern of growth to reduce the perception that there is a problem. Growth charts plotted with bone age and a target range for family size are useful for predicting adult height and managing patient and parental expectations.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
BackgroundMaintaining blood glucose levels within target is the cornerstone of diabetes mellitus management, reducing the risk of complications. Glycated haemoglobin (HbA1c) is the gold standard ...assessment, reflecting plasma glucose over 2–3 months. NICE guidance recommends four clinic attendances and HbA1c measurements per year, with a target of 48mmol/mol or lower. The National Paediatric Diabetes Audit showed a mean of 64.6mmol/mol in 2018/19. At a UK paediatric diabetes unit, face-to-face clinics (F2F) were converted to telephone appointments on 30/03/2020 due to the first COVID-19 UK lockdown. There was a phased return to F2F and HbA1c testing from June 2020.ObjectivesTo determine whether the COVID-19 pandemic and consequent national lockdown and move to telemedicine affected HbA1c levels in children with diabetes mellitus.MethodsHbA1c results were recorded throughout 2020, excluding those diagnosed in 2020. Each patient’s final HbA1c in January-March before lockdown (Pre-LD) was compared to both their first HbA1c after lockdown (Post-LD) and the mean of all of their HbA1cs after lockdown (Av-Post-LD). Comparisons were analysed grouping patients by Pre-LD, which was assumed to be their baseline.ResultsOf the 258 patients, 61 (23.64%) had no Pre-LD and 38 (14.73%) had no Post-LD, excluding them from further analysis. Numbers of F2F and HbA1c testing varied throughout the year; 92 tests were done in January, pre-pandemic, falling to 1 in April, peaking at 83 in September, dipping to 27 in December. Number of tests per patient post-lockdown varied from 1–5 (mean 1.45). When comparing results grouped by baseline, a correlation was seen (table 1).Abstract 1269 Table 1Comparison of average HbA1c(mmol/mol) pre- and post-lockdown grouped by baseline HbA1c Group Number of Subjects Pre-LD (1) Post-LD (2) Av-Post-LD (3) Improved 1–2 Improved 1–3 Improved 2–3 >69 38 86.67 76.94 76.49 Yes Yes Yes 64–69 25 65.69 61.82 61.07 Yes Yes Yes 58–63 44 60.14 58.31 59.78 Yes Yes No 53–57 23 55.35 54.23 54.63 Yes Yes No 48–52 18 50.51 52.25 52.59 No No No <48 13 42.07 44.24 46.50 No No No In the four groups with the highest initial HbA1c, improvements were seen when comparing Pre-LD to both Post-LD and Av-Post-LD, with the >69 group improving by 9.73mmol/mol and 10.18mmol/mol respectively. Only the two highest groups demonstrated a sustained improvement. In the two groups with the lowest initial HbA1c, a slight deterioration was seen when comparing Pre-LD to both Post-LD and Av-Post-LD, with a trend towards deterioration.ConclusionsPerhaps unsurprisingly, HbA1c testing fell during lockdown and never returned to pre-lockdown levels, highlighting the pandemic’s disruption to the care of patients with long-term conditions. Contrary to guidance, 14.73% of patients were not tested in the nine months post-lockdown, potentially reflecting reluctance to attend hospital during the pandemic. Nevertheless, where results were available, lockdown seemed to have a positive impact on HbA1c despite the enforced use of telemedicine, unless the patient was already close to target. It is possible that lockdown provided more routine and parental supervision for those with initially high HbA1c but disrupted the successful routine and sporting activities of those initially closer to target.
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