ISPAD Clinical Practice Consensus Guidelines 2018: Limited Care Guidance Appendix

Worldwide differences in childhood type 1 diabetes: TheSWEETexperience

“…However, as our results show self‐reported episodes of severe hypoglycaemia, recall bias might also be an explanation. Underreporting is possible, especially in regions with limited access to SMBG supplies where blood glucose monitoring might not be available when symptoms of severe hypoglycaemia arise 6 .…”

“…There are large differences in how national health services in high‐ and low‐income countries provide analogue insulin, blood glucose test strips, insulin pumps and continuous glucose monitoring (CGM) 6,7 . Low diabetes education and diabetes awareness are additional challenges in low‐income countries 6,8,9 …”

ISPAD Clinical Practice Consensus Guidelines 2018: What is new in diabetes care?

“…• acknowledge that in many regions of the world technologically advanced care may not be feasible; for this reason, an Appendix describing limited care is included as part of the guidelines. 12 As was previously stated in 2009 and 2014, "these guidelines are not strict protocols nor are they the final word". We are aware that children, adolescents, young adults, and their families who live with diabetes, are each unique and, therefore, our guidelines complement but cannot replace the guidance that a capable medical team can give in supporting the person and family living with diabetes to do so successfully and thrive.…”

“…The ISPAD guidelines are intended for worldwide application and have been drafted by an international writing team of experts in different specialties from many countries and posted for open peer review by ISPAD members via the Society's website. It is our intent and hope that the guidelines will be widely consulted and are freely available to be used to: improve awareness among governments, health care providers, and the general public of the serious long‐term implications of inadequately managed diabetes and the essential resources needed for optimal care assist individual care givers in managing children and adolescents with diabetes in a prompt, safe, equitable, standardized manner in accordance with the latest scientific knowledge, as interpreted by experts in the field provide evidence‐based advice to improve the care of children, adolescents, and young adults with diabetes acknowledge that in many regions of the world technologically advanced care may not be feasible; for this reason, an Appendix describing limited care is included as part of the guidelines …”

ISPAD Clinical Practice Consensus Guideline: Diabetic ketoacidosis in the time of COVID ‐19 and resource‐limited settings‐role of subcutaneous insulin

“…Not improving Improving F I G U R E 2 Algorithm for management of DKA outside the ICU or in the setting of limited care. 1,2,17 IV, intravenous; SC, subcutaneous; IM, intramuscular; BG, blood glucose; HCO3, serum bicarbonate (Table S2). The Cochrane review 25 analyzed the evidence from five RCTs 15,[22][23][24] between 2004 and 2011, which used SC rapid-acting insulin analogs (four lispro, one aspart) for treatment of DKA.…”