cover story
'Children spend a significant part of their day in school;
diabetes care cannot be ignored during that time.'
units. CDNS staff are usually able to with known food values (the hospital insulin pumps can now be offered
visit at home but dietetic domiciliary menu), to give confidence in their from diagnosis in children under 12.
visits are not widely available through- abilities. This may be less easy, but not This is recognising the specific advan-
out the UK. impossible; at home when there are tages of pump technology to this age
This UK review was carried out com- routine domestic distractions, food group – ability to tailor very small daily
paring traditional methods of manag- choices are more varied and dia- doses of insulin evenly throughout
ing diabetes using premixed insulins, betes team staff are unable to be in the day, coping with grazing eating
being administered twice a day, the attendance at home for all meals. patterns, frequent intercurrent illness,
doses being determined by the diabe- unpredictable eating and activity
tes teams, in response to blood glucose Treatment in schools and higher risk of hypoglycaemia. The
(BG) results. This is no longer current With more intensive regimens, number of children and young peo-
practice within our unit as multiple daily diabetes is becoming more visible in ple using pumps is likely to increase
injections (MDI) are the preferred treat- schools, as there is a need to test BG,
significantly in the next few years; in
ment option from diagnosis. inject or administer insulin at lunch-
the UK, currently only two percent of
time. The incidence of Type 1 diabe-
the Type 1 diabetes population uses
tes is increasing, especially in children
an insulin pump compared to 10-20
'The incidence of Type 1
less than five years old (7). Conse-
percent in other EU countries and 15-
quently, there are increasing numbers
20 percent in the USA.
diabetes is increasing,
of children in primary schools or early
Structured education has become
years’ settings who will need assis-
an established part of adult diabetes
especially in children less
tance or supervision of insulin at lunch-
care, and is now on the national and
time. Children spend a significant part
international agendas to improve
than five years old . . .' of their day in school; diabetes care
diabetes care for children (13,9,5,10).
cannot be ignored during that time.
Diabetes education for children
Better control of BG results in better
needs to be a continuous process
Outpatient or ambulatory care of well concentration, learning and behav-
and repeated for it to be effective
new patients may be an acceptable iour (Davis et al, 1996) so would help
(10). Several UK structured education
compromise and was offered as a sug- children in school. Schools and Local
projects are now at the national RCT
gestion by Lowes & Gregory (2004) if Education Authorities (LEAs) have an
stage – KICk-OFF (Kids In Control Of
intensive management is offered from obligation to make reasonable adjust-
Food), CASCADE (Child and Ado-
diagnosis. NICE (2004) concluded that ments to ensure that children with dia-
lescent Structured Competencies
home management at diagnosis, with betes are not put at a disadvantage
Approach to Diabetes Education),
access to 24-hour support from the (HM Government, 2001), but school
FACTS, (Family and Children’s Team-
paediatric diabetes care team, was provision of diabetes care throughout
work Study) and results will be avail-
as effective as hospital based care. the UK varies widely.
able within the next two years. Many
However, home or outpatient man- Diabetes UK has made it a priority
local services are starting to provide
agement of newly diagnosed diabetes to improve the inequalities between
their own structured education
by the diabetes team has the potential LEAs. In Every Child with Diabetes
around various aspects of diabetes
to deskill ward staff, both nursing and Matters (5), the DoH recommends
care, supported by the Diabetes Edu-
medical. When patients are admitted that school and early years settings
cation Network.
in crisis - in diabetic ketoacidosis, acute should be encouraged to offer ef-

illness or for restabilisation, ward staff fective levels of support (which may
may be less confident in their advice if require additional funding of staff) so
'Many local services
they have not had recent experience that parents do not have to attend
are starting to provide
of diabetes management. In our Trust, school to administer medicine. It
the ward provide out of hours diabetes does not have to be a teacher who
their own structured
advice via the telephone, so confi- gives the insulin – ‘non-qualified’ staff
dence in current diabetes manage- can easily be trained and may not
education around
ment, using treatment algorithms, is have the same pressures as teaching
essential. staff. Tripartite agreements between
various aspects of
Intensive management of diabe- education staff, families and health
tes, using more frequent injections is care teams can help to agree roles, diabetes care . . .'
more empowering for the families, responsibilities and adequate training.
children and young people, but in
return they should be given the op- The future? To achieve the best clinical out-
tion of protected time to practice the In the recent review of NICE guid- comes with a flexible insulin regime
new skills in a supported environment, ance for insulin pump therapy (13), (MDI or pumps), families should be
NHDmag.com Feb '10 - issue 51 9
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