Authors' objectives:

This report provides guidelines on the diagnosis and management of type 1 diabetes in children, young people and adults.

Authors' recommendations: Key priorities for implementation: children and young people 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 HbA1c 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 (see Appendix F). 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. Key messages: adults The Guideline Development Group reviewed the recommendations and summarised these key messages for implementation. Patient-centred care: The views and preferences of individuals with type 1 diabetes should be integrated into their healthcare. Diabetes services should be organised, and staff trained, to allow and encourage this. Multidisciplinary team approach: The range of professional skills needed for delivery of optimal advice to adults with diabetes should be provided by a multidisciplinary team. Such a team should include members having specific training and interest to cover the following areas of care: - education/information giving - nutrition - therapeutics - identification and management of complications - foot care - counselling - psychological care. Education for adults with diabetes: Culturally appropriate education should be offered after diagnosis to all adults with type 1 diabetes (and to those with significant input into the diabetes care of others). It should be repeated as requested and according to annual review of need. This should encompass the necessary understanding, motivation, and skills to manage appropriately: - blood glucose control (insulin, self-monitoring, nutrition) - arterial risk factors (blood lipids, blood pressure, smoking) - late complications (feet, kidneys, eyes, heart). Blood glucose control: Blood glucose control should be optimised towards attaining DCCT-harmonised HbA1c targets for prevention of microvascular disease (less than 7.5%) and, in those at increased risk, arterial disease (less than or equal to 6.5%) as appropriate, while taking into account: - the experiences and preferences of the insulin user, in order to avoid hypoglycaemia - the necessity to seek advice from professionals knowledgeable about the range of available meal-time and basal insulins and about optimal combinations thereof, and their optimal use. Arterial risk-factor control: Adults with type 1 diabetes should be assessed for arterial risk at annual intervals. Those found to be at increased risk should be managed through appropriate interventions and regular review. Note should be taken of: - microalbuminuria, in particular - the presence of features of the metabolic syndrome - conventional risk factors (family history, abnormal lipid profile, raised blood pressure, smoking). Late complications: Adults with type 1 diabetes should be assessed for early markers and features of eye, kidney, nerve, foot and arterial damage at annual intervals. According to assessed need, they should be offered appropriate interventions and/or referral in order to reduce the progression of such late complications into adverse health outcomes affecting quality of life.

Authors' methods: Clinical guideline

Project Status: Completed

URL for project: http://www.nice.org.uk/page.aspx?o=213575

Year Published: 2004

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: England, United Kingdom

Organisation Name: National Institute for Clinical Excellence

Contact Address: MidCity Place, 71 High Holborn, London WC1V 6NA, UK. Tel: +44 020 7067 5800; Fax: +44 020 7067 5801

Contact Name: nice@nice.nhs.uk

Contact Email: nice@nice.nhs.uk

Copyright: National Institute for Clinical Excellence (NICE)