Global Pediatric Endocrinology & Diabetes GPED
Global Pediatric Endocrinology and Diabetes (GPED) is a non-profit organization established in 2010. GPED aims at improving the care of children presented with endocrine disorders or with diabetes living in low and middle-income countries (LMICs) through public advocacy, training and education of local health professionals, clinical collaborations and development of translational clinical research.
Editorial
13th Edition
Welcome to our 2019 GPED fall newsletter!
Just in time before the European Society for Pediatric Endocrinology conference in Vienna, we are getting out this 13th issue, excited to promote the GPED symposium on sustainable access to affordable insulin. Join us for this informative and interactive session, followed by the GPED annual general meeting—see page 1 below for information on available positions.
In other news, our GPED’s secretary general Jean-Pierre Chanoine spent the past few months of his sabbatical working at the World Health Organization headquarters in Geneva during. In this issue, he presents some of his work on three projects relevant to global pediatric endocrinology.
1. Growth curves: The essential “vital sign” in endocrinology, find out how you can create specific growth charts for your country, using original WHO data and formatting by Canadian colleagues (pages 2-3). 2. Congenital adrenal hyperplasia: Join the discussion on whether and how we can adequately treat congenital adrenal hyperplasia in settings where hydrocortisone is unavailable. Do you agree? What is the practice in your country? What pro’s and con’s do you see? (page 4). 3. Congenital hyperinsulinism: There’s an important optimistic update for children, families and health care providers taking care of congenital hyperinsulinism: Diazoxide will be included on the next WHO list of essential medicines! Years of lobbying and a lengthy application to the WHO have finally paid out (page4).
Finally, our colleague Asma Deeb is pointing to current guidelines on diabetes management during Ramadan (page 5).
Enjoy the Read!!
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WHO Growth Curves Continued:
The characteristics of the curves include:
· Use of percentiles
· Metric system (kg, cm) and US system (inches and pounds)
· Length/height for age and weight for age are present on the chart
· Weight for age curves are include for boys and girls older than 10 years. These data are presently not available on the charts proposed online by the WHO. Most health professionals agree that BMI is the easiest and most recognized marker to evaluate body mass, in particular during puberty, when weight changes are closely linked to pubertal development. However, many health professionals also like to have the possibility to plot weight for age in all children and adolescents. A Canadian working group has calculated and included weight percentiles on the weight for age chart for children and adolescents older than 10 years. These data are presented as a dotted line, reflecting the importance of primarily using BMI to evaluate body mass, as emphasized by the WHO.
GPED has received many requests to have these charts made widely available under the name of the country where they would be used. Thanks to Public Health Agency of Canada, Canadian group for Pediatric Endocrinology, Dietitians of Canada and with the permission from Dr Mercedes de Onis (WHO, who designed and performed the study for the WHO), this is now possible.
GPED is pleased to make growth charts based on WHO data available in French, English or Spanish with the name of your country. The figures provide examples of the chats in 3 languages and for both boys and girls.
Please contact Dr Jean-Pierre Chanoine, Secretary General, GPED at info@globalpedendo.org for more information.
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​​Can CAH be effectively treated in children if hydrocortisone tablets are not available?
Your feedback is welcome and will be published in the next newsletter
The management of CAH requires administration of glucocorticoids and, when (sub)clinical salt wasting is present, fludrocortisone. None of the synthetic glucocorticoids that are presently available mimic the physiological rhythm of endogenous cortisol (early morning peak followed by a progressive decrease over 24 hours). Hydrocortisone is traditionally recommended as the first line treatment for glucocorticoid replacement in neonates and children. However, in many countries, hydrocortisone tablets are not available and other synthetic glucocorticoids need to be considered: prednisolone (PRDL), prednisone (PRED), dexamethasone (DEX) (1, 2, 3).
The greatest risk of using these more potent glucocorticoids is overtreatment, decreased height velocity and exogenous Cushing. However, when equivalence doses of 10 (HC) to 1 (PRED and PRDL) or 80-100 (DEX) to 1 (HC) are used, several authors have suggested that careful use of these more potent glucocorticoids can successfully achieve glucocorticoid replacement without side-effects.
GPED@ESPE in Vienna
Friday September 20, 2019, 1400-1600, Room TBD
The Long Winding Road towards Sustainable Access to Affordable Insulin
Join us for an exciting symposium and round table on insulin access during the ESPE meeting in Vienna on Friday September 20, 1400-1600 PM (Room TBD)
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Positions available at GPED
Elections during AGM: Sept 20 16-1700)
GPED is accepting nominations for the positions of: Secretary-General, Treasurer and Secretary: send an Email to info@globalpedendo.org
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WHO growth charts now available to GPED members in a new format!!
Get growth charts personalized with the name of your country
Available in English, French and Spanish
Background: Growth monitoring is the single most useful tool for defining health and nutritional status in children at both the individual and population level. In 2006, the World Health Organization (WHO) released new international growth charts depicting the growth of children from birth to age five years, who had been raised in six different countries (Brazil, Ghana, India, Norway, Oman, USA). Because the infants and children included in this study were raised under optimal conditions (including exclusive breastfeeding for the first four to six months of life), these WHO growth charts represent the best description of physiological growth for children from birth to five years of age. As such, they depict the rate of growth that should serve as a goal for all healthy infants and children, regardless of ethnicity, socioeconomic status, and type of feeding. Because of their prescriptive nature, they are growth standards. In 2007, motivated by the global surge in childhood obesity, the WHO also released charts for monitoring the growth of older children and adolescents. These reference curves were constructed using updated and improved data collected by NCHS (National Center for Health Statistics) in 1977 and linked to the WHO Child Growth Standards curves.
Context: Using the original WHO data, Canada has formatted the curves in order to obtain a design that is similar in appearance to growth charts used in many countries in the world and attractive for Canadian health professionals. The set consists in 8 growth charts (4 for boys and 4 for girls): length and weight for age (0-2 years), weight for length and head circumference (0-2 years), height and weight for age (2-19 years), BMI for age (2-19 years).
References
1. Whittle E and Falhammar H. Glucocorticoid regimens in the treatment of congenital adrenal hyperplasia: A systematic review and meta-analysis. J Endocr Soc 2019; 3: 1227-1245
2. Rivkees SA. Dexamethasone therapy of congenital adrenal hyperplasia and the myth of the “Growth Toxic” glucocorticoid. Int J Pediatr 2010, 2010:56968 (10 pages)
3. Rivkees SA and Stephenson K. Low-dose dexamethasone therapy from infancy of virilizing congenital adrenal hyperplasia. Int J Pediatr 2009, 2009:274682 (4 pages)
4. Manchanda A, Laracy M, Savji T, Bogner RH. Stability of an alcohol-free, dye-free hydrocortisone compounded (2 mg/ml) hydrocortisone oral solution
Management of diabetes during Ramadan
Dr Asma Deeb has worked with an international group of ISPAD (International Society for Pediatric and Adolescent Diabetes) diabetes specialists on the development of pediatric and adolescent guidelines for the management of diabetes during Ramadan. In addition, Dr Deeb is a coautor on two related sister publications. The first one summarizes the views on Ramadan fasting and examines the safety of fasting and its impact on diabetes control. The second one is a survey of the perceptions and practices related to the management of diabetes during Ramadan in children and adolescents by the members of the Arab Society for Paediatric Endocrinology and Diabetes (ASPED). Together, these three publications provide a multifaceted understanding of key aspects of the impact of Ramadan on diabetes management in Muslim children and adolescents who practice Ramadan fasting. These articles are also relevant to all pediatric endocrinologists involved in the care of Muslim children and adolescents.
Overall, a wide variation in the management of children and adolescents with diabetes during Ramadan was observed in ASPED countries emphasizing the need for guidelines. The guidelines start with an explanation of the history, importance and rationale for Ramadan in the life of a Muslim. It stresses that although observing the Ramadan fast is a key aspect of religious life, patients with chronic conditions such as diabetes are exempt from this obligation.
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References
Deeb A et al. ISPAD Clinical Practice Consensus Guidelines. Pediatr Diabetes 2019 (in press)
Beshyah SA et al. Ramadan fasting and diabetes in adolescents and children: A narrative review. Ibnosina J Med Biomed Sci 2019 (in press)
Elbarbary N et al. Management of diabetes during Ramadan fasting in children and adolescents: A survey of physicians’ perceptions and practices in the Arab Society for Paediatric Endocrinology and Diabetes (ASPED) Countries. Diabetes Res Clin Pract 2019; 150: 274-281Deeb A et al. Attitude, complications, ability of fasting and glycemic control in fasting Ramadan by children and adolescents with type 1 diabetes mellitus. Diabetes Res Clin Pract 2017; 126: 10-15
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For information and reprints, please contact Dr Asma Deeb, Paediatric Endocrinology Department, Mafraq Hospital, Abu Dhabi & Gulf University, Ajman, UAE. Email:
Fall 2019
NEW!
Yearbook in Pediatric Endocrinology
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Every year, the European Society for Paediatric Endocrinology publishes a Yearbook with expert commentaries on the most important articles published over the last 12 months. You can access the complete 2019 Yearbook free of charge at http://www.espeyearbook.org/ Drs. Julia von Oettingen and Jean-Pierre Chanoine edited the chapter on Global Health and are delighted to share it with you. To access this chapter, please click here.
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Access to care
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In the developing world, 2,210,000 children suffer from pediatric endocrine disorders and diabetes and only 1 in 10 children have access to proper care.​​
Online
Discussion :
Teleconsultations
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Need help with a challenging case?
Now GPED gives you the opportunity to discuss and consult clinical cases with a pediatric endocrinologist online!
Ghana will have the first trained pediatric endocrine nurse.
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Go to our stories and meet Deborah Amakye Ansah, who trained in Canada for two months.
Access to Fludrocortisone: from Canada to Ghana. Can your country also benefit?
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Get inspired by the story of Dr Emmanuel Ameyaw, a pediatric endocrinologist from Ghana.
Resources for Health Professionals and Families
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Browse through existing resources for patients and health professionals, or add to GPED's resources by sharing your own expertise.
Research
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We support the research done by pediatric endocrinologists in low and middle income countries; designed to improve clinical care
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GPED partnering with
Life for a Child
Increasing the provision of blood glucose meters and strips as well as HbA1c supplies to children and youth with diabetes in Haiti and Jamaica
BECOME A GPED Member
GPED is open to all pediatric endocrinologists or health professionals working in the field of pediatric endocrinology and diabetes in a low income setting.
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GPED membership is free