Doctors from our Children’s Emergency Department (ED) are launching a national study to investigate the characteristics of children and young people presenting to ED with diabetes during the Covid-19 pandemic.

The study, entitled ‘DIMPLES’ (Diabetes Mellitus in children and young people presenting to the Emergency Department during the SARS-CoV-2 pandemic), is the first of its kind. It provides healthcare professionals both nationally and internationally with ground breaking research.

DIMPLES was conceptualised in July 2020, in the midst of the first wave of the pandemic.

Caroline Ponmani (pictured) Consultant in Paediatric Emergency Medicine wrote the research proposal. She said: “We were seeing a signal in July 2020, an unusual pattern of two to three children presenting to ED with new onset diabetes in a week.

“These children were very unwell, with diabetic ketoacidosis (DKA) and a very short period of type 1 diabetes symptoms. This was a different pattern of presentation, quite unlike the natural course of type 1 diabetes.”

This concerned Caroline and made her consider whether the incidence of DKA and the associated diagnosis of type 1 diabetes was linked to Covid-19.

Caroline said: “I initially spoke to colleagues across London, the next day I got a call confirming that there were several children presenting with new onset diabetes and DKA to hospitals across London.

“Our ED at BHRUT is exposed to a wide range of illnesses; the signal was most obvious here. There was so much learning from our patients.”

Pursuing this line of inquiry, Caroline initiated and co-ordinated a diabetes network study involving 12 paediatric units in the Greater London and South-East region. This is supported by ED junior doctors, Chandu Wickramarachchi and Yvette Redpath , ED Consultants, Consultant Paediatrician Kosh Banerjee and Caroline’s mentor Tony Hulse, Consultant Endocrinologist from Evelina Children’s Hospital.

The study, which was also highlighted in the Guardian, discovered several intriguing findings.

“We found a significant increase in the proportion of children with DKA during 2020 when compared to the previous four years. This was recently presented to academic audiences on the international stage and is now published,” Caroline said.

Building upon this, Caroline was chosen to lead the DIMPLES study as the chief investigator. She is supported by the resources and expertise of the PERUKI Collaboration (Paediatric Emergency Research in the United Kingdom and Ireland).

On the support PERUKI will offer, Caroline said: “PERUKI carries out a lot of clinical research that really matters to people and they are very supportive of our study.

“PERUKI brings together clinicians and researchers who share the vision of improving emergency care of children through high quality multi-centre research . Their large network across the UK will be very valuable for this project.”

The research will be carried out across England, Wales, Scotland and Ireland.

Caroline has also been supported by Heidi Chandler, research manager from the Research and Innovation department at our trust.

Yvette, a junior doctor also supporting Caroline, highlighted the learning experience she gained from working on the study: “Before I worked with Caroline I had little experience with diabetes projects. Her knowledge and expertise, and ability to nurture my inquisitive side led me to assist in the research.

“I have learnt an awful lot, grown in confidence and enjoyed contributing to this exciting study, and have been able to translate the skills I have learnt onto a national research project.”

As DIMPLES prepares to launch, Caroline emphasises the importance of collaboration with her colleagues on the frontline: “We are very lucky to have wonderful doctors, nurses and other allied health professionals here at our trust. Their contribution and the shared learning helps us to reach great heights in research, education and training.

Caroline added: “We are so grateful to our patients and families who have contributed and allowed us to learn from their experiences and understand the proposed link between Covid-19 and diabetes in children.”