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Update: Guidance for Working with Children and Adolescents with Type 1 Diabetes

Oct 15, 2018

In 2018 and 2017 both the American Diabetes Association (ADA)1 and the International Society for Pediatric and Adolescent Diabetes (ISPAD)2 provided guidance on care and education of the child with type 1 diabetes. While the ADA paper is focused on the clinical side (diagnosis, clinical care, screening for comorbid conditions), it also touches on recommendations for the utilization of technology to enhance care (pumps and sensor),the importance of medical nutrition therapy, exercise recommendations, behavioral aspects of care, and monitoring. The latter are all aspects of diabetes self-management which can be directed under the leadership of a diabetes educator. 

The ISPAD paper specifically reviews the recommendations for diabetes education for children and adolescents. The paper leads with “Education is the key to successful management of diabetes” and is recommended as a critical element in successful diabetes management, regardless of the regimen.

In addition, in 2017, the AADE published a practice paper titled “Diabetes Educators Working with Persons with Type 1 Diabetes Over the Lifespan” which includes recommendations for working with children and adolescents with type 1 diabetes.3

What are the take home messages?

  1. Children are not just little adults
     
  2. Education should be based on a thorough assessment of the child and family. Adaptation of the material should be personalized based on the chronological and emotional stage of the patient and caregiver, along with an evaluation of the culture and learning pace.
     
  3. Most children should be treated with intensive insulin therapy, whether an insulin pump or basal bolus insulin dosing. This should include structured education.
     
  4. Lifestyle recommendations including healthy eating and regular exercise should be discussed on a routine basis. Suggestions for glucose targets and carbohydrate intake during exercise should be reviewed and individualized.
     
  5. During routine follow up care, the assessment of the child’s psychological well-being should be reviewed including history of family stress, school performance and peer interactions. Utilization of behavioral techniques that include goal setting, problem solving, coping skills and stress management should be included in the education intervention.
     
  6. As the child grows and matures, the level of self-management changes and must be evaluated on an ongoing basis as there is no “age” at which more autonomy is appropriate.
     
  7. Diabetes education for children should go beyond the walls of their home and be available to child care and school personnel.

I encourage each of you working with children to review the papers as they clarify the importance of diabetes education, provide an excellent review of the development stages, and a clear roadmap for diagnosis, monitoring and treatment options for children with type 1 diabetes.


References 

1Chiang J, Maahs D, Garvey K, Hood K et al. Type 1 diabetes in children and adolescents: A position statement by the American Diabetes Association. Diabetes Care 2018:41:2026-2044.

2Phelan H, Lange K, Cengiz E, Gallego P et al. ISPAD Clinical Practice Consensus Guidelines 2017 Compendium. Diabetes education in children and adolescents. https://cdn.ymaws.com/www.ispad.org/resource/dynamic/forums/20180111_100342_24819.pdf or www.ispad.org for the complete consensus guidelines

3https://www.diabeteseducator.org/practice/practice-documents/practice-papers


Carla Cox

About the Author:

Cox is a registered dietitian and certified diabetes educator. She has been a certified diabetes educator for over 25 years and served as an assistant adjunct professor for 14 years, teaching in areas of sports nutrition and exercise physiology. Currently she works for providence medical group in Missoula, Montana and consults on diabetes technology nationally.

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