Children - key issues

  • It is vital that children and young people receive support that meets their needs from diagnosis to transfer to adult services as this reduces the risk of complications in adulthood.
  • Management of children with diabetes in primary schools can be inadequate. Due to their age and development, children with diabetes are not always able to give their own injections or take responsibility for them. "In order to ensure children get the support they need to live a full school life, appropriate diabetes care and management from schools is crucial for the child’s short and long term health and optimum academic performance".
    See: Diabetes UK: Supporting schools with supervising or administering insulin via injections or insulin pump therapy (2008e).
  • With the inequality in diabetes care provision in schools and early years setting in mind, the RCN has published a document that outlines the principles that health care professionals  and education staff should apply to ensure the needs of children and young people with diabetes are met (Royal College of Nursing 2009 (PDF 743.0KB) [see how to access PDF files]. 
  • Most children and young people get support from specialist teams between clinical visits, usually from diabetes specialist nurses. These staff are highly regarded. (Diabetes UK 2007b).
  • Children and young people can feel isolated if links between schools and the specialist teams are weak. In a Diabetes UK members survey, the most requested improvement to care was improved communication between specialist services and school. (Diabetes UK 2007c).
  • Children with type 1 diabetes and their families should be informed that the target for long-term glycaemic control is an HbA1C level of less than 7.5% without frequent disabling hypoglycaemia and their care-package should be designed to attempt to achieve this. It is however possible that only one in seven to one in five of children, depending on age group, are meeting this target. (Department of Health 2007c).
  • Children with diabetic ketoacidosis should be treated according to the guidelines published by the British Society for Paediatric Endocrinology and Diabetes (2009).
  • Children with type 1 diabetes should be offered appropriate dietetic support to help optimise body weight and glycaemic control. They have the same basic nutritional requirements as other children with the total daily energy intake being distributed as follows: carbohydrates more than 50%, protein 10 to 15%, fat 30 to 35%.
  • The consumption of five portions of fruit and vegetables per day is also recommended, whilst neonates, infants and pre-school children require individualised dietary assessment to determine their energy needs.

Diagnosis

The diagnosis of diabetes in a child also affects the child's parents, teachers, friends and other carers. The needs of children with diabetes and their families are many and different from those of adults. Children with suspected diabetes should be offered immediate (same day) referral to a multidisciplinary paediatric diabetes care team that has the competencies to confirm diagnosis and to provide immediate and ongoing integrated package of care.

Overview of planned care

Children with newly diagnosed type 1 diabetes should be offered a structured programme of education covering the aims of insulin therapy, delivery of insulin, self-monitoring of blood glucose and the effects of diet, physical activity and other illness on glycaemic control, and the detection and management of hypoglycaemia.

The parents and any carers, including school staff, also should be offered a similar education programme, to enable the child to maintain a normal life-style. Children with diabetes and their families should be offered timely and ongoing opportunities to access information about the development, management and effects of diabetes. The information provided should be accurate and consistent and it should support informed decision-making.

The method of education and content will depend on the individual and should be appropriate for the child's or young person's age, maturity, culture, wishes and existing knowledge within the family.

Screening

According to the NICE guideline published in 2004, children with diabetes should be offered screening for:

  • coeliac disease at diagnosis
  • thyroid disease at diagnosis and annually thereafter until transfer to adult services
  • retinopathy screening annually from the age of 12 years
  • microalbuminuria annually from the age of 12 years
  • blood pressure annually from the age of 12 years.

See Diagnosis and management of type 1 diabetes in children, young people and adults (CG15). There is also a relevant section in a section of  the NICE Pathway for diabetes at Managing type 1 diabetes in children and young people.

Mental health

The complexities of managing diabetes are considerable and the pressures on children and their families can impact on mental and emotional wellbeing. Children with diabetes and their families should be offered timely and ongoing access to mental health professionals. Access to psychology services has been highlighted as an area requiring improvement (Department of Health 2007c).

References

Full details of the bracketed citations in the text above and, in many cases, links to the actual documents are available in the Reference List within this resource. Go to the Reference list.

For more information, go to: children.