Introduction

This guideline updates and replaces the sections for children and young people in type 1 diabetes (NICE guideline CG15).

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 this guideline. Preparations should also be made for the transition from paediatric to adult services, which have a somewhat different model of care and evidence base.

Type 1 diabetes is becoming more common in the UK, and since 2004 type 2 diabetes is also being diagnosed with increasing frequency. The 2013–14 National Diabetes Audit identified 26,500 children and young people with type 1 diabetes and 500 with type 2[1]. Much of the general care for type 2 diabetes is the same as for type 1 diabetes, although the initial management is different. In addition, the overweight and obesity associated with type 2 diabetes also bring an increased risk of renal complications in particular, and of problems such as hypertension and dyslipidaemia. These differences in management and complications need guidance specific to type 2 diabetes, which is included here for the first time. A variety of genetic conditions (such as maturity‑onset diabetes in the young) and other conditions (such as cystic fibrosis‑related diabetes) may also lead to diabetes in children and young people, but the care of these diverse conditions is beyond the scope of this guideline.

Since 2004 there have been major changes to the routine management of type 1 diabetes, in an attempt to achieve much stricter targets for blood glucose control to further reduce the long‑term risks associated with the condition. This national guidance is the first for children and young people to recommend attempting to reach a glycated haemoglobin (HbA1c) level near the normal range and near normoglycaemia. This tight control may be achieved by intensive insulin management (multiple daily injections or insulin pump therapy) from diagnosis, accompanied by carbohydrate counting. Newer technology such as continuous subcutaneous glucose monitoring may also help children and young people to have better blood glucose control, although this is not currently recommended for all children and young people with type 1 diabetes.

The Guideline Development Group believes that by implementing the strict blood glucose control recommended in this guideline, improvements can be made to diabetes care that reduce the impact of the condition on the future health of children and young people.

Safeguarding children

Remember that child maltreatment:

  • is common

  • can present anywhere

  • may co‑exist with other health problems, including diabetes.

See the NICE guideline on child maltreatment for clinical features that may be associated with maltreatment.

Medicines

The guideline will assume that prescribers will use a medicine's summary of product characteristics to inform decisions made with individual patients.

  • National Institute for Health and Care Excellence (NICE)