Objectives:To audit the current clinical practice of continuous subcutaneous insulin infusion (CSII) for the treatment of type 1 diabetes mellitus (T1D) in children and adolescents attending a single centre in Kuwait.Methods:A one year retrospective audit was performed in children and adolescents with T1D on CSII, who attended the paediatric diabetes clinic, Dasman Diabetes Institute during 2012. The primary outcome measure was glycaemic control as evidenced by glycated haemoglobin (HbA1c) level and the secondary outcome measures were the frequency of monitoring of the risk for microvascular complications and occurrence of acute complications and adverse events.Results:58 children and adolescents (mean age ± SD: 12.6 ± 4.1 years) were included. Mean HbA1c at baseline was 8.8% (72.7 mmol/mol) and 8.9% (73.8 mmol/mol) at the end of a 12 months observation period. Children with poor control (HbA1c >9.5% (80 mmol/mol) had a significant 1.4% reduction in HbA1c compared with the overall reduction of 0.1% (p=0.7). Rate of screening for cardiovascular risk factors and for long term complications were well documented. However, there was underreporting of acute complications such as severe hypoglycaemia and diabetic ketoacidosis. Only 1.7% of patients discontinued the pump.Conclusion:There was no significant change in HbA1c values at the end of 12 months follow up. However, HbA1c values in poorly controlled children improved. CSII requires care by skilled health professionals as well as education and selection of motivated parents and children.

BackgroundMonitoring the trends in the presentation of T1D over decades cannot be underestimated as it provides a rich source of information on diabetes-related complications like DKA. DKA represents a medical emergency, with potentially fatal outcome, and thus the prevention of DKA is a priority in diabetes care. The aim of this study is to report on trends in the presentation of DKA in children newly diagnosed with T1D in Kuwait.Material and methodsThis study is based on a retrospective review of children newly diagnosed with T1D aged 14 years or less at three Governmental Hospitals representing three health sectors out of the total six health sectors in the country during the period 2011-2017.ResultsA total of 799 children (376 males and 423 females) were newly diagnosed with T1D. 287 children presented with DKA (35.9%) with only 73 children (9.1%) classified as severe. During the years 2011 to 2017, we note that the percentage of children older than 6 years of age presenting with severe DKA has decreased significantly (p=0.022). Unfortunately, this has not been replicated in children younger than 6 years.ConclusionThis study highlights the importance of continued monitoring of clinical characteristics of children at diagnosis of T1D specifically presenting with DKA to enable diabetes care professionals to appreciate the multifaceted aspects of T1D, in particular the importance of raising awareness of the early signs of the onset of T1D with special attention to DKA and its severe consequences.

AcknowledgementThe authors would like to acknowledge the help of Ms Faten Sukkar for her initial support and conduction of the meetings. The authors would like to thank Mr. Sriraman Devarajan and his team for their cooperation and help in processing the samples and Mrs. Lorelee Tabada for her extended efforts in taking blood samples from KADS families' members. The authors would like to thank Enago (www.enago.com) for the English language review. AbstractType 1 diabetes (T1D) is one of the most common endocrine and metabolic conditions in children. In fact, this disease in children and adolescents has been increasing exponentially, with Kuwait being ranked second highest in the world regarding the number of T1D incidences.Kuwait is an oil-rich country known for its strong sense of familism, affiliative obedience, and filial obligation. Therefore, a familial study of this disease may disclose certain causative agents responsible for passing the disease on to subsequent generations.To recruit T1D patients and their family members, three different scenarios were developed.First, since Kuwaiti families are generally obedient to their doctors, the authors decided to recruit the patients through their endocrine physicians. Second, home visits were performed for meeting the families' requirements. In this case, a team consisting of one nurse, two phlebotomists (a male and a female, since some refused to be seen by the opposite gender), and a driver of the institute's car was arranged. Finally, two diabetes educators were employed to resolve any issues raised during the recruitment process. Utilizing these approaches helped convince the culturally and religiously oriented Kuwaiti families to participate in this study. In this case, the doctors and educators were not only aware of the obstacles in this population but also sensitive to the families' beliefs. This paper reports on our experience in recruitment and presents a roadmap for any future familial studies on culturally tailored societies i.e. Arab populations.Dasman Diabetes Institute's Biobank was responsible for label preparation and family coding . 90Two laboratory technicians were also available to process the samples as soon as they arrived. 91 2.3 Diabetes educator 92 Evidence-based medicine recommends educating patients about their respective diseases. In this 93 regard, diabetes education has been shown to be effective in assisting patients to make informed 94 decisions regarding the management of their disease [18]. In addition, such education can help 95 reduce disease-related tension and improve an individual's quality of life. 96 In this study, the patients were referred to a diabetes educator (DE), who taught them about the 97 disease, how to improve their diabetes control, and how to manage their diabetes on a daily 98 basis. The final and current mode of family enrollment was tailored according to the DE. The 99 authors utilized this close relationship between the patients, parents, and DE to explain the 100 importance of KADS, clarify the purpose of...