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DIABETES


AS THE INCIDENCE OF DIABETES CONTINUES TO GROW – PARTICULARLY AMONG THE YOUNG – TWO PHARMACISTS CONSIDER THE ISSUE OF ADHERENCE FOR YOUNG PEOPLE AND ASSESS THE ENHANCED ROLE FOR THE PHARMACIST IN REDUCING THE COST TO THE NHS.


CHILDHOOD AND TEENAGE DIABETES: ISSUES WITH ADHERENCE


by Gareth McCabe T


here are approximately 27,000 children and young people in the UK who have either type 1 or type 2 diabetes¹. The majority of childhood or young people with diabetes will be type 1. However, there is an increase in the amount of type 2 diabetics being diagnosed, with some children being as young as seven. A surveillance programme of children under the age of 17 in the UK found that of those diagnosed with type 2 diabetes, 95 per cent were overweight and 83 per cent were obese².


Much of the general care for type 2 diabetes is the same as for type 1 diabetes. Although the initial management is different, a tight control of their HbA1c (glycated haemoglobin) is the target.


Treatment and management of diabetes


8 - SCOTTISH PHARMACIST TYPE 1³


Insulin is the treatment for those with type 1 diabetes. The target for long- term glycaemic control is an HbA1C less than 48 mmol/mol (6.5 per cent). It is recommended that, along with insulin regimes, an integrated package providing education, support and access to psychological services should be provided.


It’s important to ensure that the programme includes the following core topics:


• insulin therapy, including its aims, how it works, its mode of delivery and dosage adjustment


• blood glucose monitoring, including targets for blood glucose control (blood glucose and HbA1c levels)


• the effects of diet, physical activity and intercurrent illness on blood glucose control


• managing intercurrent illness


(‘sickday rules’, including monitoring of blood ketones)


• detecting and managing


hypoglycaemia, hyperglycaemia and ketosis


There are three main options for treatment in type 1 diabetes. A tight control may be achieved by intensive insulin management (multiple daily injections) from diagnosis, accompanied by carbohydrate counting.


• Multiple daily injection basal– bolus insulin regimens consist of: injections of shortacting insulin or rapidacting insulin analogue before meals, together with one or more separate daily injections of intermediateacting insulin or longacting insulin analogue.


If a multiple daily injection regimen is not appropriate for a child or young person, newer technology such as continuous subcutaneous glucose


monitoring or insulin pump, may also help children and young people to have better blood glucose control.


• Continuous subcutaneous insulin infusion (insulin pump therapy): a programmable pump and insulin storage device that gives a regular or continuous amount of insulin (usually rapidacting insulin analogue or shortacting insulin) by a subcutaneous needle or cannula.


However this option may not be suitable to all children or young people.


The third option is one, two or three insulin injections per day; these are usually injections of shortacting insulin or rapidacting insulin analogue mixed with intermediateacting insulin.


TYPE 2³


First-line therapy for those with type 2 diabetes is diet and lifestyle changes and, just as for those with type 1


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