Excerpt

Clinical guidelines have been defined as ‘systematically developed statements which assist clinicians and patients in making decisions about appropriate treatment for specific conditions’. This guideline addresses the diagnosis and management of children and young people with type 1 diabetes. It has been developed with the aim of providing guidance on: initial management at diagnosis (including consideration of admission criteria and initial insulin regimens); continuing care of children and young people with type 1 diabetes; ongoing monitoring of glycaemic control (including the role of home glucose monitoring and the frequency of HbA_1c measurement); management of hypoglycaemia (insufficient blood sugar) and hypoglycaemic coma; prevention and management of diabetic ketoacidosis (including the management of intercurrent illness, that is, illness that occurs alongside type 1 diabetes, for example, influenza); peri-operative management of children and young people with type 1 diabetes; and surveillance for complications. The guideline also addresses the special needs of young people (adolescents) and the interface between paediatric and adult services.

Contents

• Update, June 2009
• Guideline Development Group membership and acknowledgements
• Abbreviations
• Glossary of terms
• 1. Introduction
  • 1.1 Aim of the guideline
  • 1.2 Areas outside the remit of the guideline
  • 1.3 For whom is the guideline intended?
  • 1.4 Who has developed the guideline?
  • 1.5 Other relevant documents
  • 1.6 Guideline methodology
• 2. Summary of recommendations and practice algorithm
  • 2.1 Summary of recommendations
  • 2.2 Future research recommendations
  • 2.3 Algorithm
• 3. Diagnosis and initial management
  • 3.1 Diagnosis
  • 3.2 Management from diagnosis
  • 3.3 Natural history of type 1 diabetes
  • 3.4 Essential education at diagnosis
• 4. Ongoing management
  • 4.1 Education
  • 4.2 Insulin regimens
  • 4.3 Insulin preparations
  • 4.4 Methods of delivering insulin
  • 4.5 Non-insulin agents (oral antidiabetic drugs)
  • 4.6 Monitoring glycaemic control
  • 4.7 Diet
  • 4.8 Exercise
  • 4.9 Alcohol, smoking and recreational drugs
  • 4.10 Long-distance travel
  • 4.11 Immunisation
• 5. Complications and associated conditions
  • 5.1 Hypoglycaemia
  • 5.2 Diabetic ketoacidosis
  • 5.3 Surgery
  • 5.4 Intercurrent illness
  • 5.5 Screening for complications and associated conditions
• 6. Psychological and social issues
  • 6.1 Emotional and behavioural problems
  • 6.2 Anxiety and depression
  • 6.3 Eating disorders
  • 6.4 Cognitive disorders
  • 6.5 Behavioural and conduct disorders
  • 6.6 Non-adherence
  • 6.7 Psychosocial support
  • 6.8 Adolescence
• 7. Continuity of care
  • 7.1 Communication between organisations
  • 7.2 Transition from paediatric to adult care
• 8. Auditable standards
• Appendix A Type 1 diabetes in children and young people. Understanding NICE guidance – information for the families and carers of children with type 1 diabetes, young people with type 1 diabetes, and the public
• Appendix B Clinical evidence forest plots
• Appendix C Young people’s consultation day
• Appendix D Management of diabetic ketoacidosis
• References
• Evidence tables

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