Sze May Ng

Edge Hill University University Liverpool MWL Teaching Hospitals

Background: Congenital hypothyroidism (CHT) affects approximately one in 3000 to 4000 infants. CHT is one of the most common preventable causes of learning difficulties. Optimal management of CHT requires early diagnosis and prompt treatment to avoid abnormal neurodevelopmental outcome. One of the main issues in the management of CHT relates to th...

Surgery can carry extra risks for people with diabetes but these risks can be reduced by following clear guidelines. Surgery and general anaesthesia cause a complex neuroendocrine stress response that can lead to hyperglycaemia and contribute to increased morbidity in patients with diabetes. To reduce the risk of such adverse outcomes, children and...

Background: The diagnostic value of tests used in assessing hypothalamic-pituitary-adrenal axis (HPA) in children remains controversial. Design: A systematic review and meta-analysis with receiver-operated-characteristic curve was undertaken to assess the diagnostic values of conventional standard dose 250 μg tetracosactrin (ACTH), short Synacth...

(1) To assess the value of cranial magnetic resonance imaging (MRI) scans in the investigation of girls with central precocious puberty (CPP); and (2) to determine the clinical predictors of abnormal cranial MRI scans in these patients. A retrospective study of 67 girls diagnosed with CPP who underwent cranial MRI scans at diagnosis. Patients with...

Babies born before 28 weeks' gestation have lower plasma thyroid hormone concentrations than more mature infants. This may contribute to their risk of poor developmental outcome. Previous studies have suggested that thyroxine supplementation for extremely preterm neonates may be beneficial. The aim of this study was to investigate the effect of adm...

This review describes the prevalence, incidence, and demographics of children and young people (CYP) with type 1 diabetes in England and Wales using data from the United Kingdom National Paediatric Diabetes Audit (NPDA) and has almost 100% submission from all paediatric diabetes centres annually. It is a powerful benchmarking tool and is an essenti...

An 11 year old female presents with a 6-week history of double and blurred vision associated with headaches and neck swelling. Thyroid function tests demonstrated antibody negative hypothyroidism. In addition, connective tissue disorder screening was negative. The patient was commenced on thyroid hormone replacement (levothyroxine).

BACKGROUND There is minimal data of health outcomes for Type 1 Diabetes (T1D) in Southeast Asia (SEA) where government funding of insulin and blood glucose monitoring either do not exist or is limited. The full impact of Covid-19 pandemic on the national economies of SEA remain unknown. In the midst of the pandemic, in 2021 HelloType1 was developed...

Objective Recurrent hypoglycaemia can result in significant neurological impairments in children and continuous glucose monitoring (CGM) technology has been shown to reduce recurrent hypoglycaemia in conditions such as congenital hyperinsulinism and metabolic disease. Design setting In the United Kingdom, CGM devices are currently only recommended...

Context In 2019, NHS England and Diabetes UK convened an Expert Working Group (EWG) in order to develop a Model and recommendations to guide commissioning and provision of mental health care in diabetes pathways and diabetes care in mental health pathways. The recommendations are based on a combination of evidence, national guidance, case studies a...

The European Society for Paediatric Endocrinology (ESPE) interactive website https://www.espe-elearning.org was first published online in 2012. We describe the various applications of the content of the e-Learning website that has been greatly expanded over the last 10 years. A large module on paediatric diabetes was added with the support of the I...

Aims Hybrid closed‐loop (HCL) systems are characterised by integrating continuous glucose monitoring (CGM) with insulin pumps that automate insulin delivery via specific algorithms and user‐initiated insulin delivery. The aim of the study was to evaluate effectiveness of HCLs on HbA1c, time‐in‐range (TIR), hypoglycaemia frequency and quality of lif...

In just a decade, Type 1 diabetes management has evolved and technology has become more widely available as part of routine self-management. This book fills a gap and clears the fog around the complexities of emerging diabetes technology such as insulin pumps, closed-loop systems and continuous glucose monitoring. It also provides essential resourc...

Introduction: Before 2016, no child was known to survive type 1 diabetes (T1D) in Laos, a lower-middle income country (LMIC) in South-east Asia. In partnership with the Laos government, a non-government organization (NGO) called Action4Diabetes (A4D) has since been providing insulin, blood glucose monitoring kits, HbA1c testing, and emergency hosp...

Hybrid closed‐loop (HCL) systems are characterised by integrating continuous glucose monitoring (CGM) with insulin pumps which automate insulin delivery via specific algorithms and user‐initiated insulin delivery. The aim of the study was to evaluate effectiveness of HCLs on Hba1c, time‐in‐range (TIR), time in hypoglycaemia, fear of hypoglycaemia,...

This will be the first publication of Type 1 diabetes (T1D) outcomes in five low-middle-income countries (LMICs)- Laos, Malaysia, Vietnam, Cambodia and Myanmar in the Southeast Asia (SEA) region. The information obtained has been possible due to partnership programmes of non-government organisation Action4Diabetes (A4D) with defined local hospitals...

One of the main drivers for change towards delivering value-based healthcare is to improve clinical and managerial culture and engagement within organisations. The relationships between clinicians and managers in an organisation are often considered to be either an enabler or disabler towards successful engagement to develop strategies towards bett...

Introduction: Automated insulin delivery (AID) systems can enable improved glycaemic outcomes with reduced mental burden. Open-source AID (OS-AID) systems overcome some of the developmental and access barriers enabling a wider use of these systems. Limited data are available on healthcare professional (HCP) opinions and current practice regarding...

Aim: To compare children with type 1 diabetes (T1D) living in the Northwest England, United Kingdom (UK) or Singapore, and to correlate age at diagnosis with birthweight and anthropometry at T1D diagnosis. Methods: We included 166 T1D children of Caucasian origin in England (UK-Caucasians) and 185 T1D children of Asian origin in Singapore (SG-As...

Continuous Glucose monitoring (CGM) and Flash glucose monitoring are new evolving technologies used in the management of Type 1 diabetes. They offer potential to improve diabetes control and reduce hypoglycaemia. CGM can be linked to insulin pump providing hybrid closed loop therapy. Families of children and young people are keen to have the benefi...

This prospective, double-blind study sought to determine the best supermarket caterpillar cake and whether the original version, Colin, could be distinguished from its descendants. A total of 42 participants at Southport and Ormskirk NHS Hospital rated the quality of the chocolate, cream filling, sponge quality and general impression of seven cater...

The onset of the COVID-19 global pandemic rapidly accelerated the use of virtual consultations into everyday practice. A solution focused approach (SFA) has been established in paediatric diabetes care, resulting in positive clinical outcomes and communication. The aim of this study was to assess feedback from paediatric diabetes patients and their...

In light of the NICE DKA 2020 publication, there remains concern that some groups will regard the guidance as an optional or discretionary advice. This commentary discusses recent jurisprudence which suggest that NICE guidelines are being increasingly viewed as mandatory by the Courts, however, there may be other factors that could result in a more...

Type 1 diabetes (T1D) is a chronic autoimmune disease of childhood affecting 1:500 children aged under 15 years, with around 25% presenting with life-threatening diabetic ketoacidosis (DKA). While first-degree relatives have the highest risk of T1D, more than 85% of children who develop T1D do not have a family history. Despite public health awaren...

Background Patient education is a fundamental aspect of self-management of diabetes. The aim of this study was to understand whether a social media platform is a viable method to deliver education to people with diabetes and understand if people would engage and interact with it. Methods Education sessions were provided via 3 platforms in a variet...

There was a trend for higher numbers of CYP with type 2 diabetes (T2D) being cared for by paediatric diabetes services. Type 1 diabetes (T1D) prevalence in CYP has remained stable at 27 653, while the number of cases of T2D has risen to 866. There were 2799 CYP aged 0-15 years who were newly diagnosed with T1D in England and Wales in 2019/20, with...

The International Society for Pediatric and Adolescent Diabetes-European Society for Pediatric Endocrinology (ISPAD-ESPE) e-learning global web portal (www.espe-elearning.org) was created in a collaboration between the ISPAD and the ESPE. This is an interactive e-learning environment for up-to-date topics in pediatric endocrinology and diabetes mel...

In this recent 2019/20 audit, 96% (168/173) of paediatric diabetes teams submitted data and included a total of 29,242 children and young people (CYP) up to the age of 24 years, and Type 1 diabetes consisted of 27,653 CYP. One of the key findings was that CYP with T1D from minority ethnic communities have higher HbA1 compared to white ethnicity and...

Do‐it‐yourself artificial pancreas system (DIY APS) uses tailor‐made open‐source software technology and algorithms to achieve automated insulin delivery (AID) systems which are not commercialised or regulated1. There is currently no guidance in the United Kingdom (UK) National Health Service (NHS) on the use of DIY APS in children and young people...

Type 1 diabetes is a self-managed condition. Regular monitoring of blood glucose (BG) levels has been the cornerstone of diabetes management. Finger prick BG testing traditionally has been the standard method employed. More recently, rapid advancements in the development of continuous glucose monitoring devices have led to increased use of technolo...

Fluid and electrolyte therapy in childhood diabetic ketoacidosis (DKA) management has been controversial. Previous National Institute for Health and Care Excellence (NICE) 2015 guidance advocated a restricted fluid regimen, while more recent guidelines have advocated a more liberal approach to fluid replacement in DKA. At the core of the debate is...

Action4Diabetes (A4D) is a small, focused UK diabetes charity that is making sustainable and scalable progress in the battle to provide quality type 1 diabetes healthcare in emerging countries across South-East Asia (SEA). A4D’s mission is to save and empower children and young people with type 1 diabetes in deprived communities across SEA by provi...

Background: Malabsorption of fat and protein contributes to poor nutritional status in people with cystic fibrosis. Impaired pancreatic function may also result in increased gastric acidity, leading in turn to heartburn, peptic ulcers and the impairment of oral pancreatic enzyme replacement therapy. The administration of gastric acid-reducing agen...

Background: Cystic fibrosis related diabetes (CFRD) is the most common comorbidity in children with cystic fibrosis (CF). Routine screening for CFRD is the oral glucose tolerance test (OGTT) where blood glucose levels are measured at 0 and 120 min. Studies have found that patients with CFRD often have an initial postprandial raised blood glucose le...

'Me and My Hormones- What Can Go Wrong' by leading award-winning paediatric endocrinologist May Ng offers a jargon-free, comprehensive account of the underlying causes of hormone conditions that can affect all ages from birth to adulthood. Hormones play a crucial role in our health, well-being, growth, puberty and sexual development. With special c...

Abstract Hybrid closed-loop systems are characterised by the coexistence of algorithm driven automated insulin delivery combined with manual mealtime boluses. Used correctly, these insulin delivery systems offer better glucose control and reduced risk of hypoglycemia and represent the most advanced form of insulin delivery available for people with...

In the UK, there have been reports of significant reductions in paediatric emergency attendances and visits to the general practitioners due to COVID-19. A national survey undertaken by the UK Association of Children’s Diabetes Clinicians found that the proportion of new-onset type 1 diabetes (T1D) presenting with diabetes ketoacidosis (DKA) during...

The global epidemiological and clinical patterns of COVID-19 among children with diabetes are still very limited. In this report Associate Professor May Ng investigates the current outcome data for young people with diabetes and COVID-19 and discusses the need for continued vigilance to ensure emergency paediatric conditions are dealt with urgently...

Certain health conditions may be associated with the autism spectrum disorder (ASD). These are described below and there is no evidence for a causal relationship with ASD. Sensory Processing Difficulties Children with ASD often have difficulty processing everyday sensory information in all senses, from noise, to touch, to smells, sounds and taste...

The National Service Framework for Children and Young People highlights the importance of effective transition care for people with chronic conditions such as diabetes. Previous research has reported deficiencies in the transition to adult services, and poorly planned care in the process is associated with increased risk of non‐adherence to treatme...

Congenital adrenal hyperplasia (CAH) is an autosomal recessive condition which leads to glucocorticoid deficiency and is the most common cause of adrenal insufficiency in children. In over 90% of cases, 21-hydroxylase enzyme deficiency is found which is caused by mutations in the 21-hydroxylase gene. Managing individuals with CAH due to 21-hydroxyl...

The Language Matters (NHS England, 2018) document highlights how important effective, understanding and emphatic language is when caring for people living with diabetes. The new model, called the Ormskirk Model, takes guidance from Language Matters and was collaboratively developed with healthcare professionals (HCPs) and those living with diabetes...

Background: Infants below 28 weeks' gestation have low thyroid hormone plasma levels compared with more mature infants and this may contribute to their risk of developmental disability. We aimed at determining the effect of supplementation with levothyroxine (LT4) for extremely premature infants born below 28 weeks' gestations on neurodevelopmental...

Introduction: Puberty is a normal process for adolescents and the first signs may include body odour, breast development or pubic hair growth. This is then followed by menarche approximately two years later. Vaginal bleeding in pre-pubertal females is rare. Methods: Seventeen patients who presented with pre-pubertal recurrent vaginal bleeding wi...

Diabetic retinopathy is a progressive ophthalmic microvascular complication of diabetes and is one of the commonest complications of Type 1 diabetes (T1D). The prevalence of diabetic eye disease varies within different population and age groups, and many risk factors are associated with the development and progression of diabetic retinopathy in T1D...

Endocrine Abstracts (2019) 66 CME4.1 | DOI: 10.1530/endoabs.66.CME4.1 Diabetes technology update (CME lecture) Sze May Ng Self-monitoring of blood glucose (SMBG) is an important part of diabetes management but only provides a snapshot view of the blood sugar at that point in time. Technology such as Freestyle Libre and Continuous Glucose Monitoring...

Solution-focused approach (SFA) offers an alternative to a ‘fix it’ or advice-driven approach. This easy-to-learn approach is derived from a psychological talking model and can be applied in practice by HCPs in order to enhance engagement with patients (Simm and Saunders, 2017), including CYP with diabetes (Christie, 2008). It essentially, through...

Background In type 1 diabetes (T1D), optimal glycaemic control requires intensive self-management to reduce the risk of complications. While routine downloading and review of blood glucose data is part of clinical practice of healthcare providers in an outpatient setting, patients and families are also educated, advised and encouraged to regularly...

Introduction The prevalence of diabetes con¬tinues to rise worldwide plac¬ing an increasing burden on the national health service. In 2012 a Best Practice Tariff (BPT) was introduced in the UK and a National Peer Review Quality Assurance Programme was developed to drive improvements in diabetes care for children and young people. Our national audit...

Background Neonatal hyperthyrotropinaemia (HT) is defined by elevated thyroid stimulating hormone (TSH) and normal free-thyroxine (FT4) level. Persistent HT in the neonatal period is often a diagnostic dilemma for clinicians to either treat to prevent subclinical hypothyroidism or to wait and monitor thyroid function tests (TFTs). Methods 2,115 te...

In the current NHS climate of driving sustainability and transformation plans and the challenges we face in the delivery of financial stability, there is good evidence that the NHS cannot be led by professional managers alone. It is essential that we involve clinicians in sharing leadership roles within an organisation (Ham et al, 2011). Effective...

Background: In 2017 the UK's Association of Children's Diabetes Clinicians (ACDC) launched a national educational package to provide training in the use of Freestyle Flash glucose monitoring (GM) to healthcare professionals. Objective: To evaluate metabolic outcomes and quality of life (QoL) of children with T1DM trained in the use of the Freest...

Compared to Europe, the UK has a higher mortality rate and significant variations in paediatric diabetes health outcomes. The National Children and Young People’s (CYP) Network, Best Practice Tariff and National Peer Review Quality Assurance Programme were developed to improve services received by CYP and, as a result, health outcomes. We aimed to...