Transcript Definitions Childhood diabetes

Report from the 10th Anniversary St Vincent
Declaration meeting
Childhood diabetes St Vincent Declaration
Main aims of managing children
with diabetes
• To ensure that children achieve:
• normal schooling and subsequent career goals
• optimal quality of life
• age-appropriate diabetes knowledge and self-care management
Childhood diabetes St Vincent Declaration
• normal growth and development
Main aim of managing children
with diabetes
• To ensure that clinics get:
Childhood diabetes St Vincent Declaration
• 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%
• no children should have HbA1c values above 10%
• severe hypoglycaemic events (loss of consciousness/ seizures) should be less
than 20 per 100 patient years
Childhood diabetes St Vincent Declaration
• 85% of children should have HbA1c values below 9%
Targets for glycaemic control
• All children with persistent microalbuminuria and/or elevated arterial
blood pressure should receive relevant management
Childhood diabetes St Vincent Declaration
• Re-admittance to hospital for recurrent episodes of ketoacidosis should
be minimised
Targets for clinic reviews
• Over 90% of all referred patients should attend the appointed clinic review visits
• Any children with a HbA1c above 10% should achieve a 1% reduction of this value
within a year
Childhood diabetes St Vincent Declaration
• 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
To reach the targets
• It is recommended that the
following should be available:
Childhood diabetes St Vincent Declaration
• 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
• 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 reeducation as required
Childhood diabetes St Vincent Declaration
• Preparation of information sheets and guidelines for parents and children about how to cope with
diabetes
Transfer to the adult clinic
• Early or late transfer (14/18 years?)
• Combined clinic (paediatric and adult team)
• Optimal time for transfer is at 18 years in connection with end of puberty,
transition from school to college or work, driving licence
Childhood diabetes St Vincent Declaration
• Transfer clinic for young adults
Transfer to the adult clinic
• None-attending patients should be reinforced to attend by their
paediatric department
Childhood diabetes St Vincent Declaration
• The paediatric and adult teams should have a common philosophy and
treatment guidelines should be the same