Type 1 diabetes: diagnosis and management of type 1 diabetes in children and young people

National Institute for Health and Clinical Excellence

Key priorities for implementation

Management from diagnosis

• Children and young people with type 1 diabetes should be offered an ongoing integrated package of care by a multidisciplinary paediatric diabetes care team. To optimise the effectiveness of care and reduce the risk of complications, the diabetes care team should include members with appropriate training in clinical, educational, dietetic, lifestyle, mental health and foot care aspects of diabetes for children and young people
• At the time of diagnosis, children and young people with type 1 diabetes should be offered home-based or inpatient management according to clinical need, family circumstances and wishes, and residential proximity to inpatient services. Home-based care with support from the local paediatric diabetes care team (including 24-hour telephone access to advice) is safe and as effective as inpatient initial management

Education

• Children and young people with type 1 diabetes and their families should be offered timely and ongoing opportunities to access information about the development, management and effects of type 1 diabetes. The information provided should be accurate and consistent and it should support informed decision-making

Monitoring glycaemic control

• Children and young people with type 1 diabetes and their families should be informed that the target for long-term glycaemic control is an HbA_1c level of less than 7.5% without frequent disabling hypoglycaemia and that their care package should be designed to attempt to achieve this

Diabetic ketoacidosis

• Children and young people with diabetic ketoacidosis should be treated according to the guidelines published by the British Society for Paediatric Endocrinology and Diabetes

Screening for complications and associated conditions

• Children and young people with type 1 diabetes should be offered screening for:
  • coeliac disease at diagnosis and at least every 3 years thereafter until transfer to adult services
  • thyroid disease at diagnosis and annually thereafter until transfer to adult services
  • retinopathy annually from the age of 12 years
  • microalbuminuria annually from the age of 12 years
  • blood pressure annually from the age of 12 years

Psychosocial support

• Children and young people with type 1 diabetes and their families should be offered timely and ongoing access to mental health professionals because they may experience psychological disturbances (such as anxiety, depression, behavioural and conduct disorders and family conflict) that can impact on the management of diabetes and well-being

full guideline available from…
National Institute for Health and Clinical Excellence, MidCity Place, 71 High Holborn, London WC1V 6NA
guidance.nice.org.uk/CG15

National Institute for Health and Clinical Excellence. Type 1 diabetes: diagnosis and management of type 1 diabetes in children and young people.. July 2004