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Diabetes in children and young people

About

What is covered

This interactive flowchart covers the diagnosis and management of type 1 and type 2 diabetes in children and young people.
Diabetes is a long-term condition that can have a major impact on the life of a child or young person, as well as their family or carers. In addition to insulin therapy, diabetes management should include education, support and access to psychological services, as detailed in these recommendations. Preparations should also be made for the transition from paediatric to adult services, which have a somewhat different model of care and evidence base.

Blood glucose and plasma glucose

The guidance refers frequently to circulating glucose concentrations as 'blood glucose'. A lot of the evidence linking specific circulating glucose concentrations with particular outcomes uses 'plasma' rather than 'blood' glucose. In addition, patient-held glucose meters and monitoring systems are all calibrated to plasma glucose equivalents. However, the term 'blood glucose monitoring' is in very common use, so in in these recommendations we use the term 'blood glucose', except when referring to specific concentration values.

Safeguarding children

Remember that child maltreatment:
  • is common
  • can present anywhere
  • may co-exist with other health problems, including diabetes.
See what NICE says on when to suspect child maltreatment for clinical features that may be associated with maltreatment.

Updates

Updates to this interactive flowchart

13 July 2016 Diabetes in children and young people (NICE quality standard 125) added.
11 February 2016 Integrated sensor-augmented pump therapy systems for managing blood glucose levels in type 1 diabetes (the MiniMed Paradigm Veo system and the Vibe and G4 PLATINUM CGM system) (NICE diagnostics guidance 21) added to blood glucose targets and monitoring.
25 August 2015 Major update upon publication of the diabetes in children and young people guideline update NG18.

Your responsibility

Guidelines

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take these recommendations fully into account, alongside the individual needs, preferences and values of their patients or service users. The application of the recommendations in this interactive flowchart is not mandatory and does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.
Local commissioners and/or providers have a responsibility to enable the interactive flowchart to be applied when individual health professionals and their patients or service users wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this interactive flowchart should be interpreted in a way that would be inconsistent with compliance with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Technology appraisals

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, health professionals are expected to take these recommendations fully into account, alongside the individual needs, preferences and values of their patients. The application of the recommendations in this interactive flowchart is at the discretion of health professionals and their individual patients and do not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.
Commissioners and/or providers have a responsibility to provide the funding required to enable the recommendations to be applied when individual health professionals and their patients wish to use it, in accordance with the NHS Constitution. They should do so in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Medical technologies guidance, diagnostics guidance and interventional procedures guidance

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take these recommendations fully into account. However, the interactive flowchart does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.
Commissioners and/or providers have a responsibility to implement the recommendations, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this interactive flowchart should be interpreted in a way that would be inconsistent with compliance with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Person-centred care

People have the right to be involved in discussions and make informed decisions about their care, as described in your care.
Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding.

Short Text

Everything NICE has said on diagnosing and managing type 1 and 2 diabetes in children and young people in an interactive flowchart

What is covered

This interactive flowchart covers the diagnosis and management of type 1 and type 2 diabetes in children and young people.
Diabetes is a long-term condition that can have a major impact on the life of a child or young person, as well as their family or carers. In addition to insulin therapy, diabetes management should include education, support and access to psychological services, as detailed in these recommendations. Preparations should also be made for the transition from paediatric to adult services, which have a somewhat different model of care and evidence base.

Blood glucose and plasma glucose

The guidance refers frequently to circulating glucose concentrations as 'blood glucose'. A lot of the evidence linking specific circulating glucose concentrations with particular outcomes uses 'plasma' rather than 'blood' glucose. In addition, patient-held glucose meters and monitoring systems are all calibrated to plasma glucose equivalents. However, the term 'blood glucose monitoring' is in very common use, so in in these recommendations we use the term 'blood glucose', except when referring to specific concentration values.

Safeguarding children

Remember that child maltreatment:
  • is common
  • can present anywhere
  • may co-exist with other health problems, including diabetes.
See what NICE says on when to suspect child maltreatment for clinical features that may be associated with maltreatment.

Updates

Updates to this interactive flowchart

13 July 2016 Diabetes in children and young people (NICE quality standard 125) added.
11 February 2016 Integrated sensor-augmented pump therapy systems for managing blood glucose levels in type 1 diabetes (the MiniMed Paradigm Veo system and the Vibe and G4 PLATINUM CGM system) (NICE diagnostics guidance 21) added to blood glucose targets and monitoring.
25 August 2015 Major update upon publication of the diabetes in children and young people guideline update NG18.

Quality standards

Quality statements

Same-day referral and appointments

This quality statement is taken from the diabetes in children and young people quality standard. The quality standard defines clinical best practice in diabetes in children and young people and should be read in full.

Quality statement

Children and young people presenting in primary care with suspected diabetes are referred to and seen by a multidisciplinary paediatric diabetes team on the same day.

Rationale

Multidisciplinary paediatric diabetes teams can confirm a diagnosis of diabetes and provide immediate care. Children and young people whose diagnosis and care are delayed are at higher risk of diabetic ketoacidosis (DKA), which is life-threatening but preventable.

Quality measures

Structure
Evidence of local arrangements and written clinical protocols to ensure that children and young people presenting in primary care with suspected diabetes are referred to and seen by a multidisciplinary paediatric diabetes team on the same day.
Data source: Local data collection.
Process
Proportion of children and young people presenting in primary care with suspected diabetes who are referred to and seen by a multidisciplinary paediatric diabetes team on the same day.
Numerator – the number in the denominator who are referred to and seen by a multidisciplinary paediatric diabetes team on the same day.
Denominator – the number of children and young people presenting in primary care with suspected diabetes.
Data source: Local data collection.
Outcome
Presentations of DKA.
Data source: Local data collection.

What the quality statement means for service providers, healthcare professionals and commissioners

Service providers (primary care services) ensure that systems are in place for children and young people presenting in primary care with suspected diabetes to be referred to and seen by a multidisciplinary paediatric diabetes team on the same day.
Healthcare professionals (such as GPs) immediately refer children and young people presenting in primary care with suspected diabetes to a multidisciplinary paediatric diabetes team, to be seen on the same day.
Commissioners (NHS England regional teams and clinical commissioning groups) commission services that make sure children and young people presenting in primary care with suspected diabetes are immediately referred to and seen by a multidisciplinary paediatric diabetes team.

What the quality statement means for children and young people and their parents and carers

Children and young people who see their GP with suspected diabetes are immediately referred to and seen by a team that specialises in caring for children and young people with diabetes. The symptoms of diabetes include feeling very thirsty or tired, needing to urinate more often than usual, or recently losing weight without trying to.

Source guidance

Definition of terms used in this quality statement

Suspected diabetes
Recognised symptoms of diabetes in children and young people include one of more of the following: increased thirst, increased urination, excessive tiredness and recent unexplained weight loss. A plasma glucose level above 11 mmol/litre indicates the presence of diabetes.
[Expert consensus and Diabetes UK]

Equality and diversity considerations

Particular care should be taken when communicating with children and young people with diabetes and their family members or carers (as appropriate) if they have, for example:
  • physical, cognitive or sensory disabilities
  • difficulties speaking or reading English.

Education and information

This quality statement is taken from the diabetes in children and young people quality standard. The quality standard defines clinical best practice in diabetes in children and young people and should be read in full.

Quality statement

Children and young people with type 1 or type 2 diabetes are offered a programme of diabetes education from diagnosis that is updated at least annually.

Rationale

Education is essential in enabling self-management of diabetes and reducing the chance of complications. It should start at diagnosis and continue throughout a person’s life. It is important to focus education on core topics and tailor it to the individual needs and learning styles of the child or young person and their family members or carers (as appropriate).

Quality measures

Structure
a) Evidence of local arrangements and written protocols to ensure that children and young people with type 1 diabetes are offered a programme of diabetes education from diagnosis that is updated at least annually.
Data source: Local data collection and 2013–14 National Paediatric Diabetes Audit.
b) Evidence of local arrangements and written protocols to ensure that children and young people with type 2 diabetes are offered a programme of diabetes education from diagnosis that is updated at least annually.
Data source: Local data collection and 2013–14 National Paediatric Diabetes Audit.
Process
a) Proportion of children and young people with type 1 diabetes who are offered a programme of diabetes education from diagnosis that is updated at least annually.
Numerator – the number in the denominator who receive a programme of diabetes education from diagnosis that is updated at least annually.
Denominator – the number of children and young people with type 1 diabetes.
Data source: Local data collection and 2013–14 National Paediatric Diabetes Audit.
b) Proportion of children and young people with type 2 diabetes who are offered a programme of diabetes education from diagnosis that is updated at least annually.
Numerator – the number in the denominator who receive a programme of diabetes education from diagnosis that is updated at least annually.
Denominator – the number of children and young people with type 2 diabetes.
Data source: Local data collection and 2013–14 National Paediatric Diabetes Audit.
Outcome
a) Quality of life.
Data source: Local data collection.
b) HbA1c level of 48 mmol/mol or lower.
Data source: Local data collection and 2013–14 National Paediatric Diabetes Audit.
c) Satisfaction of children, young people and their family members or carers (as appropriate) with the education intervention.
Data source: Local data collection and 2013–14 National Paediatric Diabetes Audit.

What the quality statement means for service providers, healthcare professionals and commissioners

Service providers (secondary care diabetes services for children and young people) ensure that systems are in place to offer children and young people with type 1 or type 2 diabetes and their family members or carers (as appropriate) a programme of diabetes education from diagnosis that is tailored to their individual needs and learning styles and updated at least annually.
Healthcare professionals (such as those providing diabetes services for children and young people) offer children and young people with type 1 or type 2 diabetes and their family members or carers (as appropriate) a programme of diabetes education from diagnosis that is tailored to their individual needs and learning styles and updated at least annually.
Commissioners (NHS England regional teams and clinical commissioning groups) commission services that offer children and young people with type 1 or type 2 diabetes and their family members or carers (as appropriate) a programme of diabetes education from diagnosis that is updated at least annually.

What the quality statement means for children and young people and their parents and carers

Children and young people with type 1 or type 2 diabetes and their family members or carers are offered a programme of diabetes education when they are diagnosed with diabetes. This education should continue throughout their life, and be updated every year.
The programme should teach them what they need to know about their condition and what changes they might need to make now that they have diabetes. This includes clear advice (designed specifically for each child or young person) on what to do when they are ill or have high blood glucose levels.

Source guidance

Definitions of terms used in this quality statement

Programme of diabetes education (type 1 diabetes)
A continuing programme of education that is age appropriate, tailored to need and revisited at least annually. The following core topics should be included from diagnosis:
  • 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 (‘sick-day rules’, including monitoring of blood ketones [beta-hydroxybutyrate])
  • detecting and managing hypoglycaemia, hyperglycaemia and ketosis.
[Adapted from Diabetes (type 1 and type 2) in children and young people: diagnosis and management (2015) NICE guideline NG18, recommendation 1.2.1 and expert opinion]
Programme of diabetes education (type 2 diabetes)
A continuing programme of education that is age appropriate, tailored to need and revisited at least annually. The following core topics should be included from diagnosis:
  • HbA1c monitoring and targets
  • the effects of diet, physical activity, body weight and intercurrent illness on blood glucose control
  • the aims of metformin therapy and possible adverse effects
  • the complications of type 2 diabetes and how to prevent them.
[Adapted from Diabetes (type 1 and type 2) in children and young people: diagnosis and management (2015) NICE guideline NG18, recommendation 1.3.1 and expert opinion]

Equality and diversity considerations

Particular care should be taken when communicating with children and young people with type 1 or type 2 diabetes and their family members or carers (as appropriate) if they have, for example:
  • physical, cognitive or sensory disabilities
  • difficulties speaking or reading English.

Intensive insulin therapy and level 3 carbohydrate-counting education for type 1 diabetes

This quality statement is taken from the diabetes in children and young people quality standard. The quality standard defines clinical best practice in diabetes in children and young people and should be read in full.

Quality statement

Children and young people with type 1 diabetes are offered intensive insulin therapy and level 3 carbohydrate-counting education at diagnosis.

Rationale

The aim of intensive insulin therapy is to reach near-normal blood glucose levels, to reduce the risk of long-term complications and improve quality of life. Dietary management can also improve control of blood glucose and HbA1c levels. When using intensive insulin therapy it is important to match the insulin dose to carbohydrate intake, in line with individualised insulin-to-carbohydrate ratios (level 3 carbohydrate-counting). Children and young people and their family members or carers (as appropriate) should be taught how to do this at diagnosis.

Quality measures

Structure
Evidence of local arrangements and written clinical protocols to ensure that children and young people with type 1 diabetes are offered intensive insulin therapy and level 3 carbohydrate-counting education at diagnosis.
Data source: Local data collection.
Process
Proportion of children and young people with type 1 diabetes who are offered intensive insulin therapy and level 3 carbohydrate-counting education at diagnosis.
Numerator – the number in the denominator who receive intensive insulin therapy and level 3 carbohydrate-counting education at diagnosis.
Denominator – the number of children and young people with type 1 diabetes.
Data source: Local data collection.
Outcome
a) HbA1c level of 48 mmol/mol or lower.
Data source: Local data collection and 2013–14 National Paediatric Diabetes Audit.
b) Quality of life.
Data source: Local data collection and 2013–14 National Paediatric Diabetes Audit.

What the quality statement means for service providers, healthcare professionals and commissioners

Service providers (secondary care diabetes services for children and young people) ensure that systems are in place to offer intensive insulin therapy and level 3 carbohydrate-counting education at diagnosis to children and young people with type 1 diabetes.
Healthcare professionals (those providing diabetes services for children and young people) offer intensive insulin therapy and level 3 carbohydrate-counting education at diagnosis to children and young people with type 1 diabetes.
Commissioners (NHS England regional teams and clinical commissioning groups) commission services that offer intensive insulin therapy and level 3 carbohydrate-counting education at diagnosis to children and young people with type 1 diabetes.

What the quality statement means for children and young people and their parents and carers

Children and young people with type 1 diabetes are offered intensive insulin therapy (either multiple daily injections or an insulin pump) and level 3 carbohydrate-counting education at diagnosis.
‘Multiple daily injections’ means injecting a long-acting (slow) insulin once or twice a day, and a rapid-acting (fast) insulin before eating. An insulin pump is a small machine connected to your body that gives you insulin throughout the day, so you don't need to inject yourself.
‘Level 3 carbohydrate counting’ means counting the carbohydrates in your food and drink, so you can make sure you are injecting the right amount of insulin.

Source guidance

Definitions of terms used in this quality statement

Intensive insulin therapy
Insulin therapy is aimed at reaching near-normal blood glucose levels. There are 2 types of intensive insulin therapy:
Multiple daily injection basal–bolus insulin regimens
An intermediate or long-acting insulin that is usually injected once or twice a day (basal), and a rapid-acting insulin that is injected as needed before each meal and snack.
[Adapted from Diabetes (type 1 and type 2) in children and young people: diagnosis and management (2015) NICE guideline NG18 (full guideline) and expert opinion]
Continuous subcutaneous insulin infusion (insulin pump therapy)
A programmable pump and insulin storage device that delivers a background or basal supply of insulin (either a rapid-acting analogue or a short-acting insulin) and boluses of insulin as needed, through a subcutaneous needle or cannula.
[Adapted from Diabetes (type 1 and type 2) in children and young people: diagnosis and management (2015) NICE guideline NG18 (full guideline) and expert opinion]
Level 3 carbohydrate counting
Carbohydrate counting for people with type 1 diabetes who are using intensive insulin regimens (multiple daily injections or insulin pump) involves calculating insulin-to-carbohydrate ratios that are individualised according to age, sex, pubertal status, duration of diabetes, time of day and activity. Pre-meal insulin is adjusted according to the estimated carbohydrate content of meals and snacks using the specified insulin-to-carbohydrate ratios.
[Adapted from Diabetes (type 1 and type 2) in children and young people: diagnosis and management (2015) NICE guideline NG18 (full guideline) and expert opinion]

Equality and diversity considerations

Particular care should be taken when communicating with children and young people with type 1 diabetes and their family members or carers (as appropriate) if they have, for example:
  • physical, cognitive or sensory disabilities
  • different cultural, ethnic or family traditions to the healthcare professional
  • difficulties speaking or reading English.

Continuous glucose monitoring in type 1 diabetes

This quality statement is taken from the diabetes in children and young people quality standard. The quality standard defines clinical best practice in diabetes in children and young people and should be read in full.

Quality statement

Children and young people with type 1 diabetes who have frequent severe hypoglycaemia are offered ongoing real-time continuous glucose monitoring with alarms.

Rationale

Continuous glucose monitoring helps children and young people with type 1 diabetes and their family members or carers (as appropriate) to respond more quickly to changes in blood glucose levels throughout the day. For children and young people with frequent severe hypoglycaemia (particularly those who have difficulty recognising or reporting it), continuous glucose monitoring can help to improve their control of blood glucose and HbA1c levels.

Quality measures

Structure
Evidence of local arrangements and written clinical protocols to ensure that children and young people with type 1 diabetes who have frequent severe hypoglycaemia are offered ongoing real-time continuous glucose monitoring with alarms.
Data source: Local data collection.
Process
Proportion of children and young people with type 1 diabetes with frequent severe hypoglycaemia who are offered ongoing real-time continuous glucose monitoring with alarms.
Numerator – the number in the denominator who receive ongoing real-time continuous glucose monitoring with alarms.
Denominator – the number of children and young people with type 1 diabetes who have frequent severe hypoglycaemia.
Data source: Local data collection.
Outcome
a) HbA1c level of 48 mmol/mol or lower.
Data source: Local data collection and 2013–14 National Paediatric Diabetes Audit.
b) Quality of life.
Data source: Local data collection and 2013–14 National Paediatric Diabetes Audit.

What the quality statement means for service providers, healthcare professionals and commissioners

Service providers (secondary care providers) ensure that systems are in place to offer ongoing real-time continuous glucose monitoring with alarms to children and young people with type 1 diabetes who have frequent severe hypoglycaemia.
Healthcare professionals (such as consultants) offer ongoing real-time continuous glucose monitoring with alarms to children and young people with type 1 diabetes who have frequent severe hypoglycaemia.
Commissioners (NHS England regional teams) commission services that offer ongoing real-time continuous glucose monitoring with alarms to children and young people with type 1 diabetes who have frequent severe hypoglycaemia.

What the quality statement means for children and young people and their parents and carers

Children and young people with type 1 diabetes who have frequent severe hypoglycaemia (a hypo that they need help from someone else to treat) are offered ongoing real-time continuous glucose monitoring with alarms. This is special equipment that checks the person’s blood glucose all the time, without them having to do finger-prick tests. It sounds an alarm if blood glucose levels fall too low.

Source guidance

Definitions of terms used in this quality statement

Frequent severe hypoglycaemia
Having low blood glucose levels that require assistance from another person to treat. ‘Frequent’ is when this is happening often enough to have a significant impact on school, work or quality of life.
[Expert opinion and Diabetes.co.uk]
Ongoing real-time continuous glucose monitoring with alarms
A type of system for continually monitoring glucose. ‘Ongoing’ means the device is used for weeks, months or longer. ‘Real-time continuous’ means the device takes real-time measurements for as long as it is worn.

Blood ketone monitoring in type 1 diabetes

This quality statement is taken from the diabetes in children and young people quality standard. The quality standard defines clinical best practice in diabetes in children and young people and should be read in full.

Quality statement

Children and young people with type 1 diabetes are offered blood ketone testing strips and a blood ketone meter.

Rationale

Insufficient insulin can lead to increased ketone levels which, if untreated, can lead to progressive dehydration and diabetic ketoacidosis (DKA). The risk of DKA is increased if a child or young person with type 1 diabetes has an illness such as flu or a urinary tract infection, or has missed some insulin doses. NICE’s guideline on diabetes in children and young people suggests that blood ketone testing is more cost effective than urine ketone testing for preventing hospital admission during intercurrent illness. It is important not to use out-of-date testing strips because the result might not be accurate. Education on how to prevent, detect and manage increased ketone levels is also vital.

Quality measures

Structure
Evidence of local arrangements to ensure that children and young people with type 1 diabetes are offered blood ketone testing strips and a blood ketone meter.
Data source: Local data collection.
Process
Proportion of children and young people with type 1 diabetes who receive blood ketone testing strips and a blood ketone meter.
Numerator – the number in the denominator who receive blood ketone testing strips and a blood ketone meter.
Denominator – the number of children and young people with type 1 diabetes.
Data source: Local data collection.
Outcome
a) DKA.
Data source: Local data collection and 2013–14 National Paediatric Diabetes Audit.
b) Hospital admission rates.
Data source: Local data collection and 2013–14 National Paediatric Diabetes Audit.
c) Mortality.
Data source: Local data collection and 2013–14 National Paediatric Diabetes Audit.
d) Satisfaction of children and young people with type 1 diabetes and their family members or carers (as appropriate) with blood ketone testing strips and blood ketone meters.
Data source: Local data collection.

What the quality statement means for service providers, healthcare professionals and commissioners

Service providers (primary and secondary care providers) ensure that systems are in place to offer children and young people with type 1 diabetes blood ketone testing strips and a blood ketone meter.
Healthcare professionals (such as GPs and consultants) offer children and young people with type 1 diabetes blood ketone testing strips and a blood ketone meter, and advise them and their parents or carers on how to prevent, detect and manage increased ketone levels.
Commissioners (clinical commissioning groups) commission services that offer children and young people with type 1 diabetes blood ketone testing strips and a blood ketone meter.

What the quality statement means for children and young people and their parents and carers

Children and young people with type 1 diabetes are offered blood ketone testing strips and a blood ketone meter to measure ketones in their blood. When people need more insulin (because they are ill or have missed some insulin doses) their body makes ketones, and too many ketones can make people very ill – this is called diabetic ketoacidosis, or DKA for short.

Source guidance

Equality and diversity considerations

Particular care should be taken when communicating with children and young people with type 1 diabetes and their family members or carers (as appropriate) if they have, for example:
  • physical, cognitive or sensory disabilities
  • difficulties speaking or reading English.

Access to mental health professionals with an understanding of type 1 or type 2 diabetes

This quality statement is taken from the diabetes in children and young people quality standard. The quality standard defines clinical best practice in diabetes in children and young people and should be read in full.

Quality statement

Children and young people with type 1 or type 2 diabetes are offered access to mental health professionals with an understanding of diabetes.

Rationale

Psychological issues (such as anxiety, depression, behavioural problems, eating disorders, conduct disorders and family conflict) and psychosocial issues have a significant and adverse impact on the management of type 1 and type 2 diabetes, and on the general wellbeing of children and young people and their family members or carers.
Children and young people with diabetes are at high risk of anxiety and depression, and it is important that they have early access to mental health professionals when they need it. Mental health professionals who have an understanding of diabetes and the particular problems it causes are essential for delivering psychological interventions and engaging with children, young people and their families.

Quality measures

Structure
Evidence of local arrangements to ensure that children and young people with type 1 or type 2 diabetes are offered access to mental health professionals with an understanding of diabetes.
Data source: Local data collection and 2013–14 National Paediatric Diabetes Audit.
Process
a) Proportion of children and young people with type 1 diabetes who are offered access to mental health professionals with an understanding of diabetes.
Numerator – the number in the denominator who have access to mental health professionals with an understanding of diabetes.
Denominator – the number of children and young people with type 1 diabetes.
Data source: Local data collection and 2013–14 National Paediatric Diabetes Audit.
b) Proportion of children and young people with type 2 diabetes who are offered access to mental health professionals with an understanding of diabetes.
Numerator – the number in the denominator who have access to mental health professionals with an understanding of diabetes.
Denominator – the number of children and young people with type 2 diabetes.
Data source: Local data collection and 2013–14 National Paediatric Diabetes Audit.
Outcome
a) Self-management of type 1 and type 2 diabetes.
Data source: Local data collection.
b) Adverse events (for example, severe hypoglycaemic episodes, diabetic ketoacidosis [DKA] or self-harm).
Data source: Local data collection.
c) Quality of life.
Data source: Local data collection and 2013–14 National Paediatric Diabetes Audit.
d) Satisfaction of children, young people and their family members or carers (as appropriate) with the intervention.
Data source: Local data collection.
e) Anxiety or depression.
Data source: Local data collection.
f) School performance or attendance.
Data source: Local data collection.

What the quality statement means for service providers, healthcare professionals and commissioners

Service providers (secondary care providers) ensure that systems are in place to offer children and young people with type 1 or type 2 diabetes access to mental health professionals with an understanding of diabetes.
Healthcare professionals (such as consultants) offer children and young people with type 1 or type 2 diabetes access to mental health professionals who have an understanding of diabetes and the particular problems it causes and can deliver psychological interventions and engage with children, young people and their families.
Commissioners (NHS England regional teams and clinical commissioning groups) commission services that offer children and young people with type 1 or type 2 diabetes access to mental health professionals with an understanding of diabetes.

What the quality statement means for children and young people and their parents and carers

Children and young people with type 1 or type 2 diabetes are able to see mental health professionals who understand the types of problems people with diabetes can have. The mental health professional should be one of the main members of the diabetes team.

Source guidance

Definition of terms used in this quality statement

Access
Multidisciplinary paediatric diabetes teams should include a psychologist, and provide access to them in an appropriate timeframe. Each child and young person with type 1 or type 2 diabetes should have an annual assessment by their multidisciplinary team to decide whether they need support from the psychologist.
[Adapted from Diabetes (type 1 and type 2) in children and young people: diagnosis and management (2015) NICE guideline NG18 (full guideline) and expert opinion]

Equality and diversity considerations

Particular care should be taken when communicating with children and young people with type 1 or type 2 diabetes and their family members or carers (as appropriate) if they have, for example:
  • physical, cognitive or sensory disabilities
  • difficulties speaking or reading English
  • an increased risk of psychological difficulties.

Effective interventions library

Effective interventions library

Successful effective interventions library details

Implementation

Information for the public

NICE produces information for the public that summarises, in plain English, the recommendations that NICE makes to healthcare and other professionals.
NICE has written information for the public explaining its guidance on each of the following topics.

Pathway information

Your responsibility

Guidelines

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take these recommendations fully into account, alongside the individual needs, preferences and values of their patients or service users. The application of the recommendations in this interactive flowchart is not mandatory and does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.
Local commissioners and/or providers have a responsibility to enable the interactive flowchart to be applied when individual health professionals and their patients or service users wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this interactive flowchart should be interpreted in a way that would be inconsistent with compliance with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Technology appraisals

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, health professionals are expected to take these recommendations fully into account, alongside the individual needs, preferences and values of their patients. The application of the recommendations in this interactive flowchart is at the discretion of health professionals and their individual patients and do not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.
Commissioners and/or providers have a responsibility to provide the funding required to enable the recommendations to be applied when individual health professionals and their patients wish to use it, in accordance with the NHS Constitution. They should do so in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Medical technologies guidance, diagnostics guidance and interventional procedures guidance

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take these recommendations fully into account. However, the interactive flowchart does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.
Commissioners and/or providers have a responsibility to implement the recommendations, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this interactive flowchart should be interpreted in a way that would be inconsistent with compliance with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Person-centred care

People have the right to be involved in discussions and make informed decisions about their care, as described in your care.
Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding.

Supporting information

Diabetes teams should have appropriate access to mental health professionals to support them in psychological assessment and the delivery of psychosocial support.

Glossary

Paths in this pathway

Pathway created: May 2011 Last updated: May 2017

© NICE 2017

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