Audit of Paediatric Diabetic Patients January 2005

1
Audit of Paediatric Diabetic Patients January 2005

• Based on NICE Guidelines for Management of
  Diabetes 2004
• Dr Susanna Hart

2
NICE September 2004 T1DM

• Initial diagnosis and management
• Continuing care
• Monitoring glycaemic control
• Management of hypoglycemia
• Sick day management
• Peri-operative management
• Surveillance for complications

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Management from diagnosis

• Ongoing multidisciplinary care
• Clinical
• Educational (structured programme)
• Dietetic
• Mental health
• Foot care
• 24 hour acess

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Ongoing managementChildren and Young people with
Diabetes

• Education at each clinic visit (age language,
  culture)

5
Insulin regimes

• Individualised regimes
• Multiple daily injection for all young people
• Dietry management
• Use of insulin delivery systems
• Use of monitoring systems
• Hypoglycemia management
• Hyperglycemia management
• Weight
• Review of insulin regime

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Aims

• HbA1c lt 7.5 (or 6.5 if microalbuminuria)
• Avoid disabling hypoglycemia
• OPD HbA1C 3 monthly
• gt 9.5 need additional support because increased
  risk of DKA and long term complications
• Self Blood glucose monitoring (with memory)
• Aim 4 8 pre-prandial lt 10 post-prandial
• Encourage self changing of dosages
• Diary

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Dietician input

• Optimise weight
• CHO 50 protein 10-15 fat 30-35
• 5 portions fruit
• Bedtime snacks
• CHO v insulin for MDI

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Ongoing care Children and young people

• Exercise
• Alcohol
• Smoking
• Travelling
• Immunisation
• Sick day rules

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Screening for complications

• Coeliac at diagnosis and 3 yearly
• Thyroid at diagnosis and annually
• Retinopathy from 12y
• Microalbuminuria from 12y
• BP from 12y
• Annual foot review
• Injection site inspection each visit
• Ht Wt BMI
• Necrobiosis lipoidica, cataracts, Addisons

10
Emotional and Behavioural

• Anxiety and Depression
• Eating disorders
• Cognotive disorders
• Non adherance
• Psychological structured behavioural intervention
• Conduct
• Family conflict

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Continuity of Care

• Local support groups
• School support
• DLA
• 3 4 OPD X year
• Young persons joint clinic