These results are similar to data from the United States but differ from European data with respect to the annual percent change for incidence as well as age-specific incidence trends. In keeping with the low mortality rates associated with type 1 diabetes, the prevalence continues to rise.

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To estimate the 11-year incidence trend of diabetic ketoacidosis (DKA) at and after the diagnosis of type 1 diabetes. Study designA retrospective cohort study using a population-based administrative cohort diagnosed with type 1 diabetes at <20 years of age from 2002 to 2012 in British Columbia, Canada. DKA at (1 episode per individual) and DKA after (multiple episodes per individual) the diagnosis of diabetes were defined as DKA occurring ≤14 days or >14 days, respectively, from diagnosis, identified using International Classification of Diseases, 9th and 10th editions codes. Incidence rate ratios were estimated using Poisson regression and DKA trends using Joinpoint regression analyses. ResultsThere were 1519 individuals (mean age at first-DKA, 12.6 ± 5.9 years; 50% male) with ≥1 DKA episode identified. Of 2615 incident cases of type 1 diabetes, there were 847 (32.4%; mean age, 9.9 ± 4.8 years; 52% male) episodes of DKA at the diagnosis of diabetes. Among prevalent cases of type 1 diabetes (1790 cases in 2002 increasing to 2264 in 2012), there were 1886 episodes of DKA after the diagnosis of diabetes (mean age at first DKA, 15.7 ± 5.2 years). The rates per 100 person-years of DKA at diabetes diagnosis (ranging from 24.1 in 2008 to 37.3 in 2006) and DKA after diabetes diagnosis (ranging from 4.9 in 2002 to 7.7 in 2008) remained stable. Females showed a 67% higher rate of incidence of DKA after the diagnosis of diabetes compared with their male counterparts (incidence rate ratio, 1.67; 95% CI, 1.50-1.86; P < .001), adjusted for the temporal trend by fiscal year. Younger age at diagnosis (<5 years) was associated with a greater risk of DKA at the time of diabetes diagnosis and older children (≥10 years) had a greater risk of DKA after the diagnosis of diabetes. ConclusionsThe risk of DKA at the time of diagnosis of diabetes was greater with younger age and the risk of DKA after the diagnosis of diabetes was higher in females and older children and youth.

Children traveling >2 hours to T1D clinic at BCCH had significantly higher HbA values and lower satisfaction with care vs those traveling <1 hour to BCCH and those receiving community care. Access to care closer to home may benefit glycemic control in children with T1D and improve treatment satisfaction. Future research should determine whether these findings can be replicated in other regions.

Background: Familial hypocalciuric hypercalcemia (FHH) results from a mutation of the calcium sensing receptor (CASR) gene and typically presents as asymptomatic hypercalcemia with inappropriately low urinary calcium excretion and normal or mildly elevated levels of parathyroid hormone. Objective: To describe a case of FHH associated with Kabuki syndrome and Crohn disease. Method: Genomic DNA was screened for CASR mutations and a retrospective chart review was performed.

Background/Objective: Diabetes-related conflict between caregiver and child has been associated with lower quality of life, reduced treatment adherence, and higher hemoglobin A1C. The objective of this project was to identify patient and family characteristics associated with higher levels of diabetes-specific family conflict. Methods: This was a cross-sectional study. Caregivers of children aged 4-to 18-years-old with type 1 diabetes were recruited from diabetes clinics across British Columbia. Data were collected through chart reviews and patient surveys, including the Diabetes Family Conflict Scale and the Adherence in Diabetes Questionnaire. All caregivers and children ≥8-years-old were invited to complete the survey. Potential predictors were explored using univariate and multivariable linear regression models. Results: In the unadjusted analysis, higher caregiver report of conflict (n = 196) was associated with: low family income, non-Caucasian ethnicity, missed school, older age at diagnosis, and insulin regimen (2-3 injections/day rather than multiple daily injections or pump). When all variables were adjusted for simultaneously, income, insulin regimen, one or more stay at home parent and recent hospitalization were significant. For the child report (n = 111), higher maternal education was associated with lower conflict in the unadjusted analysis and non-Caucasian ethnicity was associated with higher conflict in the adjusted analysis. Conclusions: This exploratory study identified possible novel associations between patient and family characteristics and diabetes-related family conflict.

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Our pediatric Gender Clinic is receiving a growing number of referrals, yet continues to operate with limited resources. To try to address this issue, a new clinical pathway was developed in 2017, which included an inter-professional assessment clinic run by nurses and social workers as the entry point for new referrals (known as ‘intake appointments’). These visits help to identify those youth who require urgent access to care (i.e. for imminent puberty), wayfinding to community supports and providers who can complete GnRH analog and hormone-readiness assessments, and information about potential medical interventions. The goals of this study were to (1) map out current processes, (2) evaluate wait times for patients referred in 2015-2016 (pre-intake) and 2018-2019 (post-intake), and (3) describe referral patterns and outcomes. Patients referred in 2017 were excluded, as this was a transitional year. In 2015-2016, 222 referrals were received, compared to 407 referrals in 2018-2019. Of the post-intake cohort, to date, 202/407 referrals have led to an intake appointment, of which 45 were via telehealth (a service not previously offered to families). Average wait time to physician visit was 171 days (range 10-1271; IQR 69-208) for patients in the pre-intake cohort, while the average wait time to intake appointment was 200 days (range 9-569, IQR 114-242) in the post-intake cohort. Wait time to physician visits cannot be assessed yet, due to the number of pending referrals. Fifty-four referrals were cancelled in the pre-intake, and 73 in the post-intake cohort. In both groups, the primary reason for cancellation was redirection by our team to other services (32% in both groups), and the second most common reason was cancellation by the family/no show to appointment (26% and 22% in the pre- and post-intake cohorts, respectively). Staffing resources and number of clinics per week have changed over the years, limiting our ability to attribute changes directly to the new clinical pathway. Moreover, most hormone-readiness assessments are completed by community providers. Therefore, wait times to physician visits partly reflect difficulty in accessing these community resources. However, using our new model of care, we have engaged with hundreds of patients and families within a similar time frame to the 2015-2016 cohort, despite an almost doubling of the number of referrals received by our clinic. Although these initial visits do not allow for initiation of medical therapy, they are a means to support patients and families through their gender journey. Moreover, the intake appointments have promoted inter-professional collaborative care, which is particularly beneficial in the face of limited resources. Thus, we believe this new model of care has led to improved quality of care for patients accessing our Gender Clinic.