Paediatric diabetes issue 121

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PAEDIATRIC COMMUNITY

PAEDIATRIC DIABETES: THE JOURNEY OF CARE FROM A DIETETIC PERSPECTIVE Kate Roberts Specialist Paediatric Diabetes Dietitian,

Kate is currently a Specialist Paediatric Diabetes Dietitian for County Durham and Darlington NHS and also works as a Freelance Dietitian. She has a wide range of clinical experience of working with adults and children.

For full article references please email info@ networkhealth group.co.uk

There are nearly 3.6 million people in the UK who have been diagnosed with diabetes.1 In 2013/14 there were approximately 31,500 children (under 19 years) with diabetes in the UK. That was broken down into: 95.1% Type 1 diabetes; 1.9% Type 2 diabetes and 2.73% maturity-onset diabetes in the young (MODY), Cystic Fibrosis related or an undefined diagnosis.2 The following article outlines the journey that patients should go through and what is considered best practice. Unfortunately, although the UK has the fourth highest number of under 19-year-olds with diabetes in Europe, it is one of the worst performing in terms of blood glucose control.3 Therefore, the guidelines for managing children and young people were revised and in 2011 the Best Practice Tariff (BPT) was introduced.4 DIAGNOSIS

Typical characteristics of Diabetes include: hyperglycaemia, polyuria, polydipsia, weight loss and excessive tiredness. Type 1 diabetes should always be assumed in children and young people unless there is a strong indication of Type 2 diabetes, monogenic or mitochondrial diabetes.5

Type 2 diabetes should be considered if the child is obese at presentation, has a strong family history of Type 2 diabetes, is of black or Asian origin or has minimal or no insulin requirements. It is still rare, but as obesity is increasing in children, incidences will unfortunately continue to rise.5 Other types of diabetes are rare and include monogenic, mitochondrial or insulin resistance syndromes. These should be suspected if diabetes occurs in the first year of life, or when ketones are not present during hyperglycaemia. There are also other features including deafness, eye problems or other systemic syndromes.5 Diabetes should be confirmed using the criteria shown in table 1. All children and young people with a suspected diagnosis of diabetes should be referred immediately to a specialist multidisciplinary team to confirm the diagnosis and commence treatment.5 A specialist paediatric diabetes multidisciplinary team (MDT) must

Table 1: 2006 WHO recommendations for the diagnostic criteria for diabetes and intermediate hyperglycaemia6 Diabetes Fasting plasma glucose

≥7.0mmol/l (126mg/dl) 2-h plasma glucose* or ≥11.1mmol/l (200mg/dl)

Impaired glucose tolerance (IGT) Fasting plasma glucose

<7.0mmol/l (126mg/dl) 2-h plasma glucose* and ≥7.8 and <11.1mmol/l (140mg/dl and 200mg/dl)

Impaired fasting glucose (IFG) Fasting plasma glucose 2-h plasma glucose** and (if measured)

6.1 to 6.9mmol/l (110mg/dl to 125mg/dl) <7.8mmol/l (140mg/dl)

* Venous plasma glucose 2-h after ingestion of 75g oral glucose load ** If 2-h plasma glucose is not measured, status is uncertain as diabetes or IGT cannot be excluded

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www.NHDmag.com February 2017 - Issue 121


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