Past ISPAD Events

February 3, 2018, Kolkata, India

On February 3, 2018 ISPAD and the Diabetic Association of India, West Bengal organized a workshop on Type 1 Diabetes Management in Kolkata, India.

The workshop was organized in collaboration with the Directorate of Health Services (NCD Section), Govt. of West Bengal. 

Workshop on Type 1 Diabetes management

Organized jointly by Diabetic Association of India, West Bengal and International Society of Pediatric and Adolescent Diabetes (ISPAD) in collaboration with Directorate of Health Services (NCD Section), Govt. of West Bengal

8.30- 9.00 am: Registration and breakfast

9.00-9.30 am: Inaugural ceremony

9.30-9.55 am Agenda Setting, T1 Diabetes Mellitus-Experience from Single Centre - Dr Sujoy Ghosh - Chairperson – Dr.Pradip Raychaudhuri, Dr.Asish K Basu

9.55-10.20 am Practical issues in Managing Type 1 Diabetes in a resource-limited Setting. - Dr Anju Virmani -Chairpersons: Dr.Banshi Saboo, Dr.Nilanjan Sengupta

10.20- 10.45 am Management of T1DM-What’s New?- David Maahs (Sectary General, ISPAD) Chairperson : Dr Subhankar Chowdhury, Dr.Supratim Datta

10.45-11.00 am TEA BREAK

11 -11.40 am WORK STATION

11.40 am-12.20 pm WORK STATION

12.20 pm -1 pm WORK STATION

1 pm - 1.40 pm WORK STATION

Module 1: Diagnosis and Monitoring (Clinical, SMBG, Laboratory)

• Dr Saumik Dutta
• Dr Indira Maisnam
• Dr Hridish Narayan Chakraborty

Module 2: Diet, Exercise, Foot and dental Care

• Dr SoumikGoswami
• Dr ParthaPratim Chakraborty
• Dr Sayantan Ray

Module 3: Insulin (Types, Regimen, Storage and Administration [including hands-on demo])

• Dr NilanjanSengupta
• Dr Purushottam Chatterjee
• Dr AnimeshMaity

Module 4: Acute complications (Hypoglycaemia, DKA, Sick day rule) and a bit of chronic complications

• Dr Rana Bhattacharjee
• Dr DebmalyaSanyal
• Dr Kaushik Biswas

LUNCH

September 24, 2017, Kota, India

On 24th Sep 2017, under the banner of ISPAD, the Internal Medicine Daswani Dental College in Kota, India organised a Free Camp and Family-Fun Day at Kota Rajasthan India. In total, 70 Underprivileged Type-1 Diabetic children (mostly girls from rural areas) with their family attended the camp.

Free Glucometers, Glucostrips,Lancets, Syringes, Insulins for 3 months and Insulin carry bags were distributed to all 70 Type -1 Diabetic Children. Free consultation, Free HbA1c test, free Fundus Examination, ACR Test Live Work shop and Education about DKA, Hypoglycaemia, Insulin Injection technique were the main features of the camp. It was a successful camp and it received media coverage .

Life for a Child (LFAC)/ISPAD Workshop

August 16-18, 2017, Georgetown, Guyana

There were 42 doctors, nurses, and pharmacists present representing all of the 10 regions of Guyana, according to Kavita. The 3 day workshop program was designed to provide further knowledge and expertise on the management of diabetes in children and young people to the attendees.

The workshop went extremely well. All of the participants were very engaged. The additional input and participation from Glynis Beaton, head of the Guyana Diabetes Association, and Dr. Indira Bhoj, resident in Family Medicine, in addition to that of Dr. Ricardo, the only endocrinologist in Guyana, made it a uniquely Guyanese workshop. Of course, the workshop would not have been possible without the organization, advice, and input re: speakers of the NCD Director of the MOPH, Dr. Kavita Singh. Anica Sanoir, RN, CCDE from Trinidad, helped make it even more Caribbean!

Forty-two doctors, nurses, and pharmacists participated representing all the 10 regions of Guyana, according to Dr. Singh. The health care professionals at the workshop will be those responsible for the February 2018 rollout for NPH and R (to replace 70/30) for those with type 1 diabetes. They will be conducting regional workshops that will be partly funded by the Ministry of Public Health (MOPH). They will be the teachers for their regions and need to submit reports as soon as they return, to ask for funds for the trainings.

The pre- and post-tests were hard to evaluate. We graded them all. Three questions were mistakenly repeated twice, meaning 3 others were left out completely. Even though the wording of many questions was altered pre-workshop and questions removed that we were not going to cover during the workshop, changes need to be made. Most people did marginally better the second time around. We reviewed all the questions at the end, and they were useful as teaching points.

The evaluations were overwhelmingly positive.

Highlights/suggestions:

1. Make small groups for teaching on insulin action, insulin adjustment, and insulin administration. Having worksheets with sample cases and having people figure out what changes to make in insulin to improve blood glucose levels would have been helpful. We did this as a large group but small groups would have been better. Perhaps this should be a standard at these workshops.
2. “Everything was useful. Personal experiences of the young people with diabetes was an eye opener – it makes you more aware of the importance of management”. This thought was echoed by many participants. The Young Leaders were basically heroes. Each of 4 of them talked about his/her daily life with diabetes to a group of about 10 participants. I think this type of session should be standard for all ISPAD workshops.
3. “Best conference I’ve ever attended.”.
4. Presentations were very clear.
5. More time is needed for the conference itself (some said a week)
6. More on DKA.
7. Many thought reviewing “key points” at the end of the workshop was very valuable. At the end of each talk key learnings were solicited from that talk and noted on butcher’s paper in full view of participants. At the end of the workshop, we reviewed all the pages as a group.
8. Anica Sanoir, diabetes educator, brought a video from Sanofi-Aventis on how to give shots by pen that participants enjoyed. They asked for more videos.
9. People asked for time to have small group discussions about the challenges in each region and how to tackle them.

Summary:

1. A group of pharmacists, nurses, and doctors from one region will contact all their children and young people with type 1 diabetes immediately following the workshop to go over learnings. Presentations were copied on flash drives at participant’s request.
2. Dr. Bhoj will use her health center for community engagement, including forming a support group and giving lectures.
3. One MD suggested that people use What’sApp and Facebook to disseminate information. Plans were made to print out the DKA warning signs poster and place it in the her MCH clinic, since lots of young people come through there.
4. HbA1c access is a problem in Guyana. There is some capacity, however, more needs to be done. It would be useful to be able to measure microalbuminuria locally.
5. It was very helpful for Anica Sanoir to be a member of the faculty, being from the Caribbean. It is essential to include a certified diabetes educator in these workshops.
6. We have offered mentorship to local health professionals.
7. We advised Guyana to follow the WHO guidelines for essential medications. NPH is not on their formulary.
8. The nutrition component should be expanded to include discussion of locally available foods, and incorporate at least two one hour sessions

Life for a Child (LFAC)/ISPAD Workshop

Twenty five doctors from Dar es Salaam and regional hospitals in Tanzania and 6 Young Leaders from the newly formed Tanzanian Diabetes Youth Alliance (TDYA) participated. The 3 days workshop’s program was designed to provide further knowledge and expertise on the management of diabetes in children and young people to the attendees.

Local Organisers:

• Dorothy McClarty, Tanzanian Diabetes Association(TDA)
• Dr Kaushik Ramaiya, Tanzanian Diabetes Association (TDA)

Faculty members:

• Ms Angie Middlehurst (AM), Deputy Manager & Director of Education, IDF Life for a Child Programme
• Dr Kenneth Robertson (KR) Paediatrician, Children’s Diabetes Service, Glasgow, Scotland
• Ms Fiona Lamb (FL), Diabetes Nurse, Children’s Diabetes Service, Glasgow, Scotland
• Dr Mariam Kolome, (MK), Paediatrician, NCD Diabetes Coordinator
• Dr Kande Muzee, Paediatrician/ Endocrinologist Muhimbili National Hospital, Dar es Salaam Dr Edna Majaliwa, Paediatrician/ Endocrinologist Muhimbili National Hospital
• Dr Faraja Chiwanga, Paediatrician. Muhimbili National Hospital Sr Elizabeth Likoko, (EL), Education/ Nutrition, Tanzanian Diabetes Association
• Ms Herieth Mganga (HM), Manager LFAC & Changing Diabetes in Children (CDiC) Programme

Participants:

• 25 doctors from Dar es Salaam and regional hospitals in Tanzania. Some were adult physicians, others Paediatricians.
• 6 Young Leaders from the newly formed Tanzanian Diabetes Youth Alliance (TDYA).

Dr Kaushik Ramaiya welcomed the faculty and opened the workshop by asking participants to provide their names and place of work.

All participants completed the mandatory pre- knowledge test before commencement of the 3 day programme.

The programme was designed to provide further knowledge and expertise on the management of diabetes in children and young people to the attendees.

All participants were very engaged, particularly during the practical session of injection technique and blood glucose testing.

The programme was altered daily, as we ascertained the local knowledge base which was quite varied.

Unfortunately there was insufficient time to include school issues and transition was briefly mentioned in the Puberty and Adolescence session.

Participants asked for more information on Carbohydrate Counting, so this was covered by KR on the final morning.

AM spoke about the LFAC Programme and it became obvious that some attendees were not well aware of the details of the programme, so the session was useful. It also provided an opportunity to stress the importance of annual data collection and reports.

Camps and LFAC Resources:

The TDYA were an impressive group, very engaged and keen to be involved. They joined in the Camp session with comments about the benefits they had gained from attending camp. Each participant received a copy of the second edition of the ISPAD/LFAC Pocketbook Guidelines, in addition to the recently developed flow charts.

The “Professor Bumblebee’s Guide to Type 1 Diabetes DVD was shown and copies left to use at TDA. Dorothy is keen to have this translated into Swahili. AM distributed copies of the Swahili version of “Moseka and her Friends” and highlighted the Swahili page on the LFAC Education website.

Participants completed their post-test which demonstrated an increase in knowledge of type 1 diabetes. Since the workshop, the TDYA have been very active and enthusiastic on social media regarding carbohydrate counting, uploading food pictures and generating discussion.

Post workshop comments from participants via DM:

• Most Drs were stimulated, intensive practical training
• Drs would like to have access to recent publications and learn new things about T1dm research.

Local recommendations:

• Keep in regular contact with clinics
• Help them to conduct their own small research such as what is the eating habits of children at the clinic, support from family, facing stigma @ school, conducting meetings with head teachers of schools attended.
• Encourage the Drs to write this up and TDYA to organise regional meetings where data is presented.
• Encourage Drs to communicate with each other across country and share findings, experiences and difficulties etc.

Faculty recommendations:

• KR, FL and AM to mentor local H/P as required.
• Encourage the doctors to introduce a regimen of 3-4 injections per day, rather than bd mixed insulin, where this is practical.
• Encourage regular blood glucose monitoring as many times as strip availability allows. Generally, there seem to be enough strips to allow 4 tests per day.
• Immediate introduction of correction dosing – explained in detail on last day.
• Encourage commencement of CHO counting – Beatrice is adding to her already comprehensive list of local foods – she will send this to KR and he will discuss with his dietitian and add CHO content as this is currently lacking.
• Identified that it is vitally important to follow up the participants of the workshop in 6 months’ time and possibly repeat the post-test. Dorothy is keen to do this to ensure that care is improved and chase up data.
• Part of this should be indication of implementation of correction doses and/or CHO counting.
• Following AM’s LFAC session, Dr Robertson discussed the importance of “return on investment” on support received from LFAC. The TDA and Dr Ramaiya have an excellent rapport with the government and The NCD Coordinator, (MK), was keen to proceed further.
• Encourage the TDYA – they are a very sensible group of young people with type 1 diabetes, are keen to help and are great role models for other young people. TDA value their input, however, the local doctors may need persuading, and also accepting the multi-disciplinary team approach.
• AM to add DM to receipt of the bi-monthly LFAC Education Bulletin. She will send AM a list of the doctor’s emails so that they receive them too.

2nd International Symposium in Diabetes Technology

It is the main congress related to technology in the country. With the support of ISPAD, Past-President Ragnar Hannas is coordinating the workshop, aiming to produce step-by-step guidelines to be published on the Brazilian Society of Diabetes website to be made available country-wide. All doctors working with Type 1 diabetes patients are invited to attend. We hope that this initiative will increase the number of patients that benefit from pump therapy.

On April, 20 we had the opportunity to organize the 1st SBD-ISPAD Workshop, joining ISPAD and the Brazilian Diabetes Society.

RATIONALE:
Brazil is one of the countries with more patients with T1D in the world, and less than 1% is on pump treatment. Besides social and economic challenges, one other important barrier was the difficult access to information for doctors due to continental size of the country. The majority of patients using pumps are concentrated in state capitals and big cities, where information and support is more widely seen.  In other places, diabetes services lack diabetes educators, and other HCP. It was noted that there was a need of a more practical guideline to facilitate this process.

THE WORKSHOP:
Coordination: Luis Eduardo Calliari
Supervision and orientation: Ragnar Hanas
Comments: Ralph Ziegler
Speakers: 11 speakers were invited to make a summary of specific topics.
Attendants: 64 attendants

• 58 physicians
• 6 HCP

TOPICS:

1. Indications of pump therapy
2. Characteristics of the pumps in Brazil
3. Training patients for pumps
4. Pump for kids  < 2 years
5. Pumps for toddlers and school children
6. Pumps for adolescents
7. How to deal with sick days
8. Pump and exercise
9. Emergencies
10. Recommendations of monitoring (SMBG and CGM)
11. Sensor: How to adjust alarms
12. Upload and analysis of data

There was great discussion and interaction between audience and speakers about each topic. ISPAD representative, Ragnar Hanas, commented upon the presentations, gave suggestions and helped to design the final messages. General impression was that there was a great opportunity to discuss and learn about pumps. We are now in the process of developing a quick guide to be published online and in paper.


Luis Eduardo Calliari
Coordinator of the Department of Diabetes in the Young – SBD
Member of ISPAD Advisory Council

Youth-onset Type 2 Diabetes: Current Status, Challenges, and Priorities

October 20, 2015, Hilton Mark Center, Alexandria, VA, USA

A full day meeting was convened of representatives from industry, academia, funding agencies, policy makers, advocacy groups and regulators. Presentations were given to provide background information on existing evidence and knowledge gaps. Following the presentations, a panel with audience participation examined the regulation, study design and outcome measures of pediatric research in type 2 diabetes (T2D). Following the in-person meeting, the key participants re-convened to summarize the state of knowledge and construct a consensus statement paper on challenges and priorities in youth-onset T2D.  This statement paper will appear in an upcoming issue of Diabetes Care.

Process:

A full day meeting was convened of representatives from industry, academia, funding agencies, policy makers, advocacy groups and regulators. Presentations were given to provide background information on existing evidence and knowledge gaps. Following the presentations, a panel with audience participation examined the regulation, study design and outcome measures of pediatric research in type 2 diabetes (T2D). Following the in-person meeting, the key participants re-convened to summarize the state of knowledge and construct a consensus statement paper on challenges and priorities in youth-onset T2D.  This statement paper will appear in an upcoming issue of Diabetes Care.

Objectives:

The objectives for this consensus conference were to review the current state of knowledge and controversies surrounding T2D in children, including understanding the fundamental similarities and differences between childhood and adult disease, the current therapeutic options, and to discuss the challenges and priorities for developing new approaches.

Statement of need:

T2D is an emerging and devastating disorder in adolescents and young adults and there are unique challenges in studying as well as caring for these children. T2D disproportionately impacts youth from disadvantaged backgrounds and occurs in an environment where we don’t know how to deliver durable lifestyle change. The disordered lifestyle of these youth is not only the reason they get T2D, but also the reason they are difficult to treat, and the reason they are difficult to study.  Current approaches are not working and treatment options remain very limited. For example, we do not know how to help youth with T2D change their lifestyles, we have only 2 FDA approved drugs for T2D youth (insulin and metformin) despite many more being approved in adults, and we have been unable to complete drug trials of new agents in T2D youth. Therefore, we require clear strategies for research, prevention and treatment of diabetes in these vulnerable patients. Because our current approach is not working, we are not yet ready to publish updated treatment guidelines, and therefore a consensus conference was convened to begin to address the barriers to improving the lives of youth with T2D.

Evidence suggests that T2D in children differs in many ways from type 1 diabetes. However, it remains unclear exactly what facets are similar to adults with T2D and which facets are unique to youth with T2D. Clarifying whether T2D in youth is a fundamentally different disease or the same disorder just occurring earlier, is critical to deciding which aspects of the care of adults with T2D can be extrapolated to youth, and which areas require separate approaches. We don’t yet know how to best treat youth with T2D and need a better understanding of the biology. Numbers of youth in each country are relatively small, yet T2D in youth has an overwhelming impact on each youth, with large future financial repercussions to health care systems world-wide. Therefore, well-designed clinical trials with international cooperation are required. Understanding the unique pathophysiology of T2D in youth, as well as the risk of complications and the adverse psychosocial, economic and cultural milieu pediatric T2D occurs in, will enable industry, academia, funding agencies, advocacy groups, policy makers and regulators to collectively evaluate both current and future research, treatment and prevention approaches. The development of T2D in youth, a disorder that youth should be protected against, is like a canary in a mine signaling that something fundamental in society has gone wrong, thus cooperation with all stakeholders and international cooperation across borders is urgently required.

Collaborators:

The American Academy of Pediatrics, the International Society for Pediatric and Adolescent Diabetes, and the Pediatric Endocrine Society were collaborating organizations with the American Diabetes Association.  A special thanks to Dr Kristen Nadeau, co-chair of the conference for providing this summary and overview.

Research School for Physicians 2012 (Lodz)

Lodz, Poland, November 15-21, 2012

The first Sanofi ISPAD Research Course for Physicians was held in Lodz, Poland on November 15-21 2012. Professor Wojciech Mlynarski and his colleagues welcomed 16 students from 11 countries while the faculty comprised 7 lecturers from Poland, Marian Rewers, Tim Barrett and Kenneth Robertson representing ISPAD and Dragana Milo representing Sanofi Aventis.

The programme began with an excellent overview of the worth of Clinical Trials from the President of Diabetes Poland, Leszek Czupryniak and a welcome buffet. A major coup for the school was the venue - a hotel converted from a warehouse in Lodz which is part of a historic industrial complex that is now redeveloped as a major leisure and retail park. The excellent meeting and conference facilities ensured that the breakout sessions and plenary groups had first class facilities.

The faculty presented lectures on topics as diverse as Pharmacogenetics, Cancer and Diabetes and "The Dark Side of Power" - a highly stimulating exposition of how to calculate power for clinical studies.

Of course, the main meat of the programme was from the students who presented their proposals for research projects and were then subjected to a barrage of questions and challenges from their colleagues. As always, it was easier for the students who gave their presentations early because by the last day, the analytical skills of all attending had improved significantly.

The range and quality of the proposals was very wide but, far from being detrimental, this forced diversity of thought and it was clear that the challenges facing some of the participants were great on political, financial and intellectual levels.

It wasn’t all work, and our organisers had ensured that we had a thorough understanding of the history and culture of Lodz by the time we left with museum visits, poetry and a very stimulating trip to the Lodz Film School where Roman Polanski studied. It was just as well we paid attention as that evening students and faculty were invited to produce a short film advertising the benefits of ISPAD - this was challenging and fun. We hope that Sanofi will be sufficiently encouraged by the obvious success of their first joint venture with ISPAD and will be minded to continue the collaboration beyond the second such Research Science School which will be held in Boston in the Spring of 2014.

From a personal viewpoint, I know that I learned much and I am certain that the students will have formed friendships that will endure and hopefully result in useful research collaborations in the future. We look forward to seeing the fruits of their labours at forthcoming Annual Conferences.

Kenneth J. Robertson (Treasurer)

Students opinion: Marta Buraczewska from Poland:

"ISPAD Research Course in Lodz was a great one week experience. First of all we could get an up-date on all important aspects of diabetes. We had a chance to work with world class speakers with no barrier to ask them anything we wanted. Discussing my research project with other students and lectures was really helpful for me".

"At the Course a great impact was made on adequate research plan and working with appropriate statistic tools. All student were very happy to improve their statistic skills. Finally, the ISPAD Research Course was a great opportunity to meet young researchers from all over the world. We had a great networking!".

Changing Diabetes in Children training in Guinea

November 1-4, 2012

Changing Diabetes in Children was held in Conakry, Guinea. ISPAD, CHU Donka (team of internal and pediatric medicine in Conakry) in collaboration with Novo Nordisk and Roche organized a 4-day course for local nurses, pediatricians and internists.

Over a four day period, representatives from different teams (nurses, pediatricians and internists) in Guinea-Conakry met for a training meeting, organized by the team of internal and pediatric medicine in Conakry (CHU Donka, Prof. Naby Balde et dr Moustafa Kouyate) in collaboration with ISPAD, Novo Nordisk and Roche.

Talks and group workshops have led to a very fruitful and active exchange between all participants. The course included lectures as well as group discussions and a clinic visit. National challenges as well as possible solutions have been discussed. First epidemiological data from Guinea since the Changing Diabetes in Children program began show an increase in the number of children with a classical type 1 childhood-onset diabetes. The number of very young children seems still less than expected, requiring further research.

Several patients were discussed who did not present in the typical fashion of type 1 or type 2 diabetes. Possible collaboration with the Exeter team to share cases of rare forms of diabetes has been initiated. An anonymous evaluation by the participants clearly showed positive feedback and the need to continue the training of health care professionals in the field of childhood diabetes.

Jean Jacques Robert and Carine de Beaufort, ISPAD
Naby Balde and Moustafa Kouyate, CHU Donka