11. Children and Adolescents

Abstract

TYPE 1 DIABETESThree-quarters of all cases of type 1 diabetes are diagnosed in individuals ,18 years of age. The provider must consider the unique aspects of care and management of children and adolescents with type 1 diabetes, such as changes in insulin sensitivity related to physical growth and sexual maturation, ability to provide self-care, supervision in the child care and school environment, and neurological vulnerability to hypoglycemia and hyperglycemia in young children, as well as possible adverse neurocognitive effects of diabetic ketoacidosis (1,2). Attention to family dynamics, developmental stages, and physiological differences related to sexual maturity are all essential in developing and implementing an optimal diabetes regimen (3). Due to the paucity of clinical research in children, the recommendations for children and adolescents are less likely to be based on clinical trial evidence. However, expert opinion and a review of available and relevant experimental data are summarized in the American Diabetes Association (ADA) position statement "Care of Children and Adolescents With Type 1 Diabetes" (4) and have been updated in the ADA position statement "Type 1 Diabetes Through the Life Span" (5).A multidisciplinary team of specialists trained in pediatric diabetes management and sensitive to the challenges of children and adolescents with type 1 diabetes and their families should provide care for this population. It is essential that diabetes self-management education (DSME) and support (DSMS), medical nutrition therapy, and psychosocial support be provided at diagnosis and regularly thereafter by individuals experienced with the educational, nutritional, behavioral, and emotional needs of the growing child and family. The appropriate balance between adult supervision and independent self-care should be defined at the first interaction and reevaluated at subsequent clinic visits. The balance between adult supervision and independent self-care will evolve as the adolescent gradually becomes an emerging young adult. Diabetes Self-management Education and SupportRecommendation c Youth with type 1 diabetes and parents/caregivers (for patients aged ,18 years) should receive culturally sensitive and developmentally appropriate individualized diabetes self-management education and support according to national standards at diagnosis and routinely thereafter. BNo matter how sound the medical regimen, it can only be effective if the family and/ or affected individuals are able to implement it. Family involvement is a vital component of optimal diabetes management throughout childhood and adolescence. Health care providers (the diabetes care team) who care for children and adolescents must be capable of evaluating the educational, behavioral, emotional, and psychosocial factors that impact implementation of a treatment plan and must work with the individual and family to overcome barriers or redefine goals as appropriate. DSME and DSMS require periodic reassessment, especially as the youth grows, develops,...

Patient Perspectives on Nurse-led Consultations Within a Pilot Structured Transition Program for Young Adults Moving From an Academic Tertiary Setting to Community-based Type 1 Diabetes Care

“…Unfortunately, this confluence of issues often results in deteriorating glycemic control. International data have identified significant shortfalls as only about 14% patients with T1DM aged 11-18 years actually achieve glycated hemoglobin (HbA1c) levels of b7.5% (Dunger, 2017;Maahs et al, 2014;Miller et al, 2015) which is the consensus target identified by the American Diabetes Association (ADA) and the International Society for Pediatric and Adolescent Diabetes (ISPAD) (American Diabetes, 2016;Rewers et al, 2014).…”

Effectiveness of Computer Automation for the Diagnosis and Management of Childhood Type 2 Diabetes

“…26 However, such programs are not widely available, not covered by insurance, and often not accessible by the target population. 27,28 …”

Pediatric diabetes training for healthcare professionals in Europe: Time for change

“…Nevertheless, the salient themes highlighted in this study, standardized EU-CDEC in place, first, education and training will be aligned according to evidence-based practices and current global health policy and guidelines. 12,17,[27][28][29][30] Second, clear teaching and learning pathways will be created that act as a common language, facilitating greater mobility of HCPs between countries to enhance professional experience and expertise. Third, greater quality assurance will help to increase standards among the diabetes workforce and equally, raise the profile of diabetes educators collectively.…”