No abstract

Purpose Glucose monitoring [GM] is a mainstay of diabetes control and management. Improving glycemic control is essential to prevent microvascular complications. However, adherence to GM can be a challenge in children and adolescents. Detecting hypoglycemia is essential for its prevention and treatment. We aim to study the impact of the flash ambulatory glucose monitoring in detecting hypoglycemia and enhancing adherence in children and adolescents with type 1 diabetes. Methods The study is prospective involving 3 hospital visits. Children and adolescents with diabetes were enrolled in the study which involved a period on conventional glucose self-monitoring [glucometers] followed by a similar period of monitoring using the flash glucose monitoring device (FreeStyle Libre). Frequency of GM, duration and frequency of hypoglycemia were compared on conventional and the flash monitoring. Results 75 subjects were studied. Age mean (range) was 11.9 years (2-19). Significant difference was seen in hypoglycemia detection between both testing devices. 68 (94%) and 65 (90%) patients detected nocturnal and diurnal hypoglycemia respectively on Flash monitoring compared to 12 (16.6%) and 30 (41%) on glucometer testing (p < 0.00). Mean (range) duration of hypoglycemia was 95 min (15-330). Statistically-significant difference was found between the frequency of GM on glucometer testing compared with Flash monitoring (2.87 and 11.6/day) (p < 0.001). Conclusions Flash monitoring is a useful tool to improve adherence to GM and detecting hypoglycemia [diurnal and nocturnal] in children and adolescents with type 1 diabetes.

BackgroundParental anxiety about the impact of puberty/menses, particularly in girls with severe disability leads to seeking therapeutic pubertal suppression. We aim to explore maternal attitudes and reasons for seeking pubertal suppression.MethodsMothers of girls receiving gonadotropin -releasing hormone analogue therapy in Mafraq hospital, Abu Dhabi were enrolled in the study. A semistructured interview was conducted to ascertain possible reasons for delaying puberty. The study group was divided into girls with a disability with central precocious puberty (CPP) or normal puberty and girls without a disability presenting with CPP.Results42 mother–daughter pairs were enrolled and divided into two groups; group A: 15 girls with CPP with no disability; group B: 27 girls with disability (10 had CPP (group B1) and 17 had normal pubertal timing (group B2)). Mothers in group A aimed to delay puberty, while in group B, 13 (48%) mothers desired to halt puberty and 7 (26%) requested permanent surgical intervention. Fear of short stature (15, 100%), inability to cope psychologically (10, 67%) and fear of peer rejection (9, 60%) were the main concerns in group A. In group B, mothers were concerned about menstrual hygiene management (25, 92.5%), fear of child abuse or unwanted pregnancy (15, 55%) and fear of inability to express pain/discomfort with menstruation (8, 30%).ConclusionMothers of girls with a disability commonly seek medical help to delay/halt puberty due to concerns about menstrual hygiene. Short final height was the main concern for girls without a disability. Culture and religion play an important role in puberty management in girls with a disability.

PurposeInsulin pumps are widely used in diabetes. They are equipped with safety alarms to alert users. Pump manuals contain alarm codes and how to troubleshoot them. However, these manuals are lengthy and difficult to use, particularly in emergencies. We aim to assess the impact of targeted education on warnings and errors in improving competency to troubleshoot the alarms.MethodsTwenty-one patients, with a median age of 13, were recruited over a 5-month period. Each patient had 2 study visits. The frequencies and types of alarms were recorded, and patients were given a summary sheet that outlined common alarms encountered and troubleshooting tips. In visit 2, the frequencies and types of alarms were compared to those of visit 1. The patients were asked to fill a questionnaire and to rate the education session given in visit 1, their level of competency in decrypting alarm codes, and their promptness in responding to alarms.ResultsLow cartridge (W1), low battery (W2), and bolus cancelled (W8) were the commonest warnings. The most noted errors were occlusion (E4), power interruption (E8), empty battery (E2), set not primed (E11), and cartridge empty (E1). The numbers of warning and error signals markedly decreased after targeted education (P<0.05). The ability in decrypting warning signals significantly improved (P=0.02), and the frequency of response to pump alarms significantly increased (P=0.001).ConclusionsCertain warnings and errors are more common than others in insulin pumps. Targeted education is useful in improving competency and response of patients in managing pump alarms.

Background The use of interferon gamma-release assays (IGRA) has become a very useful tool in the detection of latent tuberculosis (LTB) among patients on biological disease modifying anti-rheumatic drugs (bDMARDs). The IGRA offers some advantages over the intradermal tuberculin skin test (TST), such as, no requirement to re-schedule the patient for the test reading, the elimination of the inter-reader variability and higher specificity. These features facilitate the decision making when deciding which patients require tuberculosis (TB) chemoprophylaxis before starting bDMARDs, particularly in world regions with high incidence of vaccinated individuals and new TB cases. In our tertiary level hospital, the IGRA QuantiFERON-TB Test® (Cellestis Ltd, Australia), was introduced as routine screening test for LTB in late 2008 together with the usual chest X-ray, initially run concurrently and then substituting the old TST in most of the cases. Objectives In this report, we present the benefits of its use in decreasing the number of active TB cases among rheumatoid arthritis (RA) patients prescribed bDMARDs in our centre. Methods An audit was undertaken through the electronic medical record system of our hospital, which was implemented from January 2011 for all medical documentation. All RA patients aged 18 and over seen in the rheumatology outpatient clinic between Jan 2011 and September 2013 and on bDMARDs at any time during this period were identified. Among the cohort of RA patients on bDMARDs, we searched for patients with diagnosis of active TB or receiving anti-TB triple/quadruple therapy. Results were compared to previous RA cohort from the same hospital from the period 2003-2008, which was facilitated by two of the authors of this present paper who worked in our hospital during this period. Results Ninety-seven individuals diagnosed with RA and treated with any of the bDMARDs available during the study period were found. There were no documented cases of TB or active TB treatment among the 97 individuals on bDMARDs during the 34-month audit period. This contrasts with the three cases of TB reactivation among the 86 patients who received bDMARDs in our centre from 2003 to 2008. Conclusions Our data suggest that the IGRA QuantiFERON-TB Test® is more useful than the TST for the LTB screening in adult population on bDMARDs. This is particularly important in mixed populations with a high percentage of individuals being nationals from endemic countries in TB. Our recommendation is to systematically use IGRA in such settings, repeating this on an annual basis. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.5158