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Report from the 10th Anniversary St Vincent Declaration meeting. Main aims of managing children with diabetes. To ensure that children achieve: normal growth and development normal schooling and subsequent career goals optimal quality of life
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Main aims of managing children with diabetes • To ensure that children achieve: • normal growth and development • normal schooling and subsequent career goals • optimal quality of life • age-appropriate diabetes knowledge and self-care management
Main aim of managing childrenwith diabetes • To ensure that clinics get: • access to a quality focused computer programmes for easy data handling and surveillance
Targets for glycaemic control • Within 5 years: • 50% of children should have HbA1c values below 8% • 85% of children should have HbA1c values below 9% • no children should have HbA1c values above 10% • severe hypoglycaemic events (loss of consciousness/ seizures) should be less than 20 per 100 patient years
Targets for glycaemic control • Re-admittance to hospital for recurrent episodes of ketoacidosis should be minimised • All children with persistent microalbuminuria and/or elevated arterial blood pressure should receive relevant management
Targets for clinic reviews • Over 90% of all referred patients should attend the appointed clinic review visits • Over 90% should have screening programme for complications at the age of 9,12,15 and 18 years at least and yearly examinations if the metabolic control is unsatisfactory or abnormalities are found • Any children with a HbA1c above 10% should achieve a 1% reduction of this value within a year
To reach the targets • It is recommended that the following should be available: • multidisciplinary paediatric team, specially trained in diabetes, paediatrics and adolescent medicine: paediatrician, nurse educator, dietitian, psychologist with easy access to podiatrist, social worker and hospital teacher • regular meetings of the diabetes team with the aim of establishing a quality circle to develop common goals and philosophy of diabetes treatment • 24 hour hotline dedicated telephone service • increased postgraduate education and training opportunities for the team
Structured education programmes • Preparation of age-appropriate education programmes, adjusted according to needs of the child and the level of maturity and family support • Preparation of information sheets and guidelines for parents and children about how to cope with diabetes • Organisation of peer-related activities outside the clinic setting (like camps, support groups, etc.) to enhance the educational programmes within the clinic should be encouraged • Audits of the knowledge of diabetes and the theory of diabetes treatment among children and re-education as required
Transfer to the adult clinic • Early or late transfer (14/18 years?) • Combined clinic (paediatric and adult team) • Transfer clinic for young adults • Optimal time for transfer is at 18 years in connection with end of puberty, transition from school to college or work, driving licence
Transfer to the adult clinic • The paediatric and adult teams should have a common philosophy and treatment guidelines should be the same • None-attending patients should be reinforced to attend by their paediatric department