Type 1 diabetes - redGDPS

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Summary of recommendations and practice algorithmYoung people with type 1 diabetes should be offered specific support strategies, suchas mentoring and self-monitoring of blood glucose levels supported by problemsolving, to improve their self-esteem and glycaemic control.Families of children and young people with type 1 diabetes should be offered specificsupport strategies (such as behavioural family systems therapy) to reduce diabetesrelatedconflict between family members.Children and young people with type 1 diabetes and their families should be offeredtimely and ongoing access to mental health professionals because they mayexperience psychological disturbances (such as anxiety, depression, behavioural andconduct disorders and family conflict) that can impact on the management ofdiabetes and wellbeing.Diabetes care teams should have appropriate access to mental health professionals tosupport them in the assessment of psychological dysfunction and the delivery ofpsychosocial support.6.8 AdolescenceDiabetes care teams should be aware that adolescence can be a period of worseningglycaemic control, which may in part be due to non-adherence to therapy.Chapter 7 Continuity of care7.1 Communication between organisationsChildren and young people with type 1 diabetes and their families should be offeredinformation about the existence of and means of contacting local and/or nationaldiabetes support groups and organisations, and the potential benefits of membership.This should be done in the time following diagnosis and periodically thereafter.Diabetes care teams should liaise regularly with school staff involved in supervisingchildren and young people with type 1 diabetes to offer appropriate diabeteseducation and practical information.Teaching staff should be informed about the potential effects of type 1 diabetes oncognitive function and educational attainment.Children and young people with type 1 diabetes and their families should be advisedhow to obtain information about benefits in relation to government disability support.7.2 Transition from paediatric to adult careYoung people with type 1 diabetes should be encouraged to attend clinics on aregular basis (three or four times per year) because regular attendance is associatedwith good glycaemic control.Young people with type 1 diabetes should be allowed sufficient time to familiarisethemselves with the practicalities of the transition from paediatric to adult servicesbecause this has been shown to improve clinic attendance.Specific local protocols should be agreed for transferring young people with type 1diabetes from paediatric to adult services.The age of transfer to the adult service should depend on the individual’s physicaldevelopment and emotional maturity, and local circumstances.Transition from the paediatric service should occur at a time of relative stability in theindividual’s health and should be coordinated with other life transitions.Paediatric diabetes care teams should organise age-banded clinics for young peopleand young adults jointly with their adult specialty colleagues.Young people with type 1 diabetes who are preparing for transition to adult servicesshould be informed that some aspects of diabetes care will change at transition. Themain changes relate to targets for short-term glycaemic control and screening forcomplications.AAGPPGPPBGPPGPPGPPGPPDGPPGPPGPPDDGPP17
Type 1 diabetes2.2 Future research recommendations18Chapter 4 Ongoing management4.1 EducationFurther research is needed to evaluate the effectiveness of age-specific structured educationprogrammes covering all aspects of care in children and young people with type 1 diabetes,their families and other carers.Further research is needed to evaluate the effectiveness of education programmes in whichyoung people with type 1 diabetes provide training for their peers.Further research is needed to determine the most effective way of training healthcareprofessionals to provide education about type 1 diabetes in children and young people.4.2 Insulin regimensResearch is needed to compare the effectiveness of multiple daily injection regimens with twicedailyinjection regimens in children and young people with type 1 diabetes.Research is needed to compare the effectiveness of continuous subcutaneous insulin infusion (orinsulin pump therapy) and multiple daily injection regimens in children and young people withtype 1 diabetes.4.3 Insulin preparationsResearch is needed to evaluate the effectiveness of long-acting insulin analogues in children andyoung people with type 1 diabetes.Further research is needed to evaluate the effectiveness of once-daily injection regimens inchildren and young people with type 1 diabetes, and especially in pre-school children.4.4 Methods of delivering insulinFurther research is required to evaluate the effectiveness of insulin delivery systems in childrenand young people with type 1 diabetes.Research is needed to compare the effectiveness of insulin delivery modes (for example, dermal,nasal, oral and pulmonary) in children and young people with type 1 diabetes.4.5 Non-insulin agents (oral antidiabetic drugs)Further research is needed to evaluate the effectiveness of metformin combined with insulintreatment in children and young people with type 1 diabetes.4.6 Monitoring glycaemic controlResearch is needed to investigate the clinical implications of alternative site monitoring (forexample, the arm as opposed to the finger) in children and young people with type 1 diabetes.Research is needed to evaluate the clinical effectiveness of the routine use of invasive and noninvasivecontinuous glucose monitoring systems for optimising glycaemic control in childrenand young people with type 1 diabetes.4.7 DietFurther research is needed to evaluate the effectiveness of training in flexible, intensive insulinmanagement to enable children and young people with type 1 diabetes to adjust insulin dosesto match carbohydrate intake.Chapter 5 Complications and associated conditions5.2 Diabetic ketoacidosisFurther research is needed to evaluate the role of blood ketone monitoring in preventing diabeticketoacidosis in children and young people with type 1 diabetes.Further research is needed to investigate the effectiveness of different concentrations ofrehydration fluid, the rate of rehydration, the use of albumin infusion and the dose of insulininfusion in the management of diabetic ketoacidosis in children and young people.
Page 2 and 3: Type 1 diabetes: diagnosisand manag
Page 4 and 5: ContentsGuideline Development Group
Page 6 and 7: Guideline DevelopmentGroup membersh
Page 8 and 9: Guideline Development Group members
Page 10 and 11: Glossary of termsBiasBlinding or ma
Page 12 and 13: Glossary of termsCross-sectional st
Page 14 and 15: Glossary of termsPowerProspective s
Page 16: Glossary of termsSystematic reviewV
Page 19 and 20: Type 1 diabetesA separate guideline
Page 21 and 22: Type 1 diabetesTable 1.1 Levels of
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Page 25 and 26: Type 1 diabetesAt the time of diagn
Page 27 and 28: Type 1 diabetesChildren and young p
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Page 43 and 44: Type 1 diabetespsychosocial support
Page 45 and 46: Type 1 diabetesself-monitoring of b
Page 47 and 48: Type 1 diabetesIndometacinOne RCT h
Page 49 and 50: Type 1 diabetesdiagnosed type 1 dia
Page 51 and 52: Type 1 diabetesdiabetes management.
Page 53 and 54: Type 1 diabetes• advising childre
Page 55 and 56: Type 1 diabetes• initial and cont
Page 57 and 58: Type 1 diabetesyears) involved in t
Page 59 and 60: Type 1 diabetesThe DCCT found no si
Page 61 and 62: Type 1 diabetesSpecial insulin regi
Page 63 and 64: Type 1 diabetesHbA 1c was lower aft
Page 65 and 66: Type 1 diabetesEstablished users of
Page 67 and 68: Type 1 diabetesTwo rapid-acting hum
Page 69 and 70: Type 1 diabeteslevels (7.07 ± 0.51
Page 71 and 72: Type 1 diabetesThree RCTs reported
Page 73 and 74: Type 1 diabetesinsulin zinc suspens
Page 75 and 76: Type 1 diabetes4.4 Methods of deliv
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Page 83 and 84: Type 1 diabeteshypoglycaemia: 1.75
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Type 1 diabetesstorage of blood sam
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Type 1 diabetesThree studies in the
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Type 1 diabetesperformed on a month
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Type 1 diabetesthat a memory was fi
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Type 1 diabetesas well as performin
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Type 1 diabetespackage of care that
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Type 1 diabetesWe found four studie
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Type 1 diabetesChildren and young p
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Type 1 diabetesdiabetes care teams.
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Type 1 diabetesSmokingSmoking has b
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Type 1 diabeteswere hospitalised wi
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Type 1 diabetesWhat is the optimum
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Type 1 diabetesIntranasal glucagon
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Type 1 diabetesadmission for diabet
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Type 1 diabetesContinuous versus in
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Type 1 diabetesSomatostatin therapy
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Type 1 diabetes5.3 SurgeryWe found
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Type 1 diabetesMaintaining hydratio
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Type 1 diabetesdiagnosed at or befo
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Type 1 diabetesA consensus guidelin
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Type 1 diabetespeople with optimal
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Type 1 diabetesIn children under th
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Type 1 diabetesand venlafaxine (sel
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Type 1 diabetesSummaryYoung women w
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Type 1 diabeteschildren and young p
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Type 1 diabetesA theoretical model
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Type 1 diabetesAnother RCT compared
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Type 1 diabetesYoung people with ty
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7. Continuity of care7.1 Communicat
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Type 1 diabetesRESEARCH RECOMMENDAT
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Type 1 diabetesYoung people with ty
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Type 1 diabetesRecommendation Crite
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Appendix AType 1 diabetes in childr
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Appendix ASometimes, it’s possibl
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Appendix AChildren’s diabetes car
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Appendix AIf a child or young perso
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Appendix Aperson who has multiple d
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Appendix A• Providing they are aw
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Appendix Aespecially linked to chil
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Appendix AFor further information a
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Appendix BClinical evidence forest
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Appendix BFigure B.3 HbA 1c - studi
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Appendix BFigure B.5 Hypoglycaemic
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Appendix BFigure B.7 Patient prefer
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Appendix CYoung people’s consulta
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Appendix DManagement of diabetic ke
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Appendix DA. General:Always accept
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Appendix D• staffing levels on th
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Appendix D• If needed, a solution
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Appendix DAPPENDIX 1Glasgow Coma Sc
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References1. Smith AHK. The Nationa
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References59. Satman I, Dinccag N,
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References2003 [unpublished].121. N
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Referencesinsulin lispro in continu
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Referencesin diabetic patients. Ann
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References301. Kilpatrick ES. Probl
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References367. Marrero DG, Kronz KK
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References428. Donaghue KC, Pena MM
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References496. Edge JA, Ford-Adams
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References1995;38:607-11.562. Morte
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References627. Harrison-Woolrych M,
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Indexacademic achievement 114acarbo
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Indexdiagnosis 22-4, 134-5algorithm
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Indexrecommendations 13, 88immunoth
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Indexneonates (newborn babies) 6, 1
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Indexsuicide 111sulphonylureas 64-5
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