ESPE Abstracts

Introduction: Diabetic ketoacidosis (DKA) is a known complication of diabetes mellitus, mainly type1. It is a medical emergency condition. The recent British paediatric DKA guideline clearly recommends involving a senior clinician at time of diagnosis, usually either an emergency medicine or general paediatric doctor. There is no clear recommendation of when to consult the on-call paediatric endocrinologist or diabetologist who covers the admission of diabetic cases.

Aim: This comparative analytic study aims to review the response of Bahraini, Iraqi, and Saudi paediatric residents throughout their different levels of training, regarding when they would consult the on-call consultant covering diabetes.

Methods: An online survey was sent out to the paediatric residents practicing in Bahrain, Iraq, and Saudi Arabia between May and July 2020. The questionnaire included a question asking about the timing of when to consult the paediatric endocrinologist during management of acute DKA, giving them four different options.

Results: 142 residents responded to this questionnaire (41 from Bahrain, 41 from Iraq and 60 from Saudi Arabia). Majority do involve their seniors at time of diagnosis but timing to consult the paediatric endocrinologist varied (Table 1). The highest responses of consulting the endocrinologist whilst the patient is still in the emergency room received from the Saudi residents (28, 47%). 12 residents from Bahrain (29%) would run the consultation only if the child requires intensive care unit admission and 29% of Iraqi residents were not sure when to consult.

Discussion: COVID-19 lockdown was not associated with a significant worsening of glycaemic control in CYPD. BMI trended upwards during lockdown, although not statistically significant. Further evaluation of the effect of the pandemic on BMI and HbA1C should be studied carefully through national audits. This will also reflect the impact and analysis of virtual clinics.

Conclusion: There was a noticeable variation of approaches from the paediatric residents. Uncertainty of when to consult the on-call clinician who covers diabetes was evident. Exploring the practice from different countries would be warranted and a recommendation from the international societies could be useful to unify the approach and ensuring patients’ safety