Frequency and mortality associated with Hyperglycemia in critically ill children

Objective: To determine the frequency of hyperglycemia in critically ill children admitted in PICU of a tertiary care hospital of Karachi and to compare the mortality of critically ill children with and without hyperglycemia

Study Design: Cross-sectional study

Place and Duration of Study: Paediatrics Intensive Care Unit [PICU] of National Institute of Child Health [NICH], Karachi, from November 2011 to April 2012

Methodology: One hundred fifty critically ill children admitted to PICU were included. Patients who had fasting blood sugar levels more than 126 mg/dl within 48 hours of admission were included in the hyperglycemic group. The normoglycemic and hyperglycemic groups were followed till 10 days to determine the mortality associated with hyperglycemia

Results: Out of 150 patients, 82 [54.7%] had hyperglycemia. Mortality rate was 48.7% [n=73/150]. However, mortality rate was significantly high 57.3% [n=47] in hyperglycemic patients than non-hyperglycemic patients [p=0.019]

Conclusion: The presence of stress-induced hyperglycemia in critically ill patients is a well established marker of poor outcome, and a very high mortality rate. Normoglycemia was associated with favorable outcomes in terms of hospital stay and mortality

Hyperinsulinemia and waist circumference in childhood metabolic syndrome

To determine the characteristics of obese children presenting at a tertiary care hospital and the frequency of metabolic syndrome [MS] in them using two paediatric definitions. Cross-sectional study. The Endocrine Clinic of National Institute of Child Health, Karachi, from November 2005 till May 2008. A total of 262 obese children aged 4-16 years, with BMI greater than 95th percentile were included Children having obesity due to syndromes, medications causing weight gain, chronic illness and developmental disability were excluded. Blood pressure, waist circumference, fasting triglycerides, HDL, insulin and glucose levels were obtained. Obesity was defined as BMI > 95th percentile for age and gender according to the UK growth reference charts. The prevalence of metabolic syndrome was estimated using to the De Ferrantis and Lambert definitions. The frequency of MS varied between 16% and 52% depending on whether insulin levels were included in the definition. There was a significant positive correlation[r] when the metabolic parameters were correlated with waist circumference and insulin levels, except HDL which was negatively correlated. All the metabolic parameters like waist circumference, triglycerides, high density lipoprotein cholesterol and systolic blood pressure increased considerably circumference, triglycerides, high density lipoprotein cholesterol and systolic blood pressure increased considerably across the insulin quartile [p< 0.05]. The most noteworthy anthropometric and metabolic abnormality were the waist circumference [46.5%] and insulin levels [58%] respectively. There was a marked difference in the frequency of metabolic syndrome according to the definition used. The waist circumference and hyperinsulinemia are significant correlates of MS in obese children. There is a need for establishing normal insulin ranges according to age, gender and pubertal status. The clinical examination and investigations ought to include waist circumference and insulin levels together as a part of the definition of MS, for early detection and intervention of childhood obesity

Effects of diabetes self-management education on glycaemic control in children with insulin-dependent diabetes mellitus

To evaluate the effect of diabetes self-management education [DSME] on glycaemic control [HbA1c] in Pakistani children suffering from type-1 diabetes mellitus. Quasi-experimental study. This study was conducted at the Diabetic OPD of National Institute of Child Health, Karachi, from April to September 2009. Sixty children with a mean age of 9.94 years with type-1 Diabetes mellitus [T1DM] were selected conveniently from the diabetic OPD. The patients along with their parents/caregivers attended a modular series of diabetes self-management education program consisting of 2 sessions. Customized program was designed to educate children regarding general information about the disease, basic insulin therapy, planning for hypoglycaemia, hyperglycaemia, activity, traveling and basic nutritional management. It was conducted by a multidisciplinary paediatric diabetes team including an endocrinologist, general paediatrician, nutritionist and diabetic nurse. The educational sessions were followed by monthly revision exercises. HbA1c levels were measured at baseline and after 3 months and compared using paired sample t-test. Out of a total of 60 patients, 50 completed the trial. There was a significant decrease in the HbA1c levels after the DSME program. The mean pre- and postintervention HbA1c levels were 9.67 +/- 0.65 and 8.49 +/- 0.53 respectively with a p-value < 0.001. In the studied group, DSME programs helped to improve glycaemic control. It should be an integral part of patient treatment in diabetic care setups