cover story
The changing face of children’s
diabetes in the UK
by Frances Robson
Paediatric Diabetes Dietitian
Frances Robson is a paediatric diabetes dietitian at Leeds
Teaching Hospitals NHS Trust. She is currently on secondment as
an educator on the Kids in Control of Food (KICk-OFF) children’s
structured diabetes education study, led by Sheffield Children’s
Hospital.
The management of children’s diabetes in the UK is changing. Intensive insulin regimes, new technologies and
structured education programmes are gradually becoming part of routine practice in the UK. Lack of dietetic
hours, insufficient nursing staff and resistance from schools may all be contributing to the slow progress of
adopting intensive insulin regimes as standard practice amongst all ages of children.
Diabetes is one of the most common these; empowerment and self man- with variable food intake, differing
chronic conditions affecting children agement are recognised features of family routines and unpredictable
and young people of all ages, social positive outcomes for adults with dia- activity. Even in the absence of clini-
and ethnic backgrounds (5). Currently betes (6) and are now recommenda- cal improvements, the advantages
in the UK, life expectancy is reduced tions for children and families affected of flexibility allowing diabetes to fit
on average by 23 years in people by diabetes (5). into family life should not be underes-
with Type 1 diabetes (12), which is timated. Families within focus groups
still the most common type occurring Flexible insulin regimes recognise the potential improvements
in children, despite the rise in Type 2 Current NICE guidance (13) rec- to quality of life from insulin flexibility,
diabetes in childhood (8). It is widely ommends multiple daily injections despite the increased number of
documented that more than 75 per- (MDI) for children > 11 years old. For injections (14).
cent of British children with diabetes pre-school and primary school aged There is a debate in the UK and be-
are currently failing to meet satisfac- children, NICE recommends that they yond as to whether hospital or home
tory clinical outcomes (measured should be offered the most appro- management of diabetes is prefer-
as glycated haemoglobin, HbA1c < priate insulin regimen for their own able at diagnosis for children. In a re-
7.5%, or 58mmol/mol) (2,12,5). circumstances. International guide- view of UK practice, it was concluded
This is unacceptable and insulin lines (1) recognise that in pre-pubertal that both methods of management
treatments are becoming increasingly children there is no clear evidence were equally effective at delivering
intensive amongst paediatric casel- that premixed insulin is less clinically diabetes care, providing that com-
oads, moving away from a traditional effective, but it reduces the flexibility munity staffing levels were sufficiently
twice daily mixed insulin regime. Suc- offered by administering long and adequate (11). Although home man-
cessful clinical outcomes for children rapid acting analogues separately. agement was the preferred option of
may have a multifactorial aetiology It is acknowledged that flexibility is these authors, they acknowledged
with family dynamics contributing to advantageous when treating children this may not be appropriate for all
8 NHDmag.com Feb '10 - issue 51
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