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Canadian Diabetes Association 2008 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada, Canadian Journal of Diabetes, Vol 32, Sup 1

Children with Diabetes under 18 yearsbyMaggie Stelmaschuk (Bellefountaine )RD MSA CDE

Children with Diabetes under 18 yearsbyMaggie Stelmaschuk (Bellefountaine )RD MSA CDETYPE 1 and TYPE 2 DIABETES IN CHILDRENAND ADOLESCENTS

2008 Clinical Practice Guidelinesfor the Prevention and Managementof Diabetes in CanadaCanadian Diabetes Association 2008 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada, Canadian Journal of Diabetes, Vol 32, Sup 1Children are not little adults

Diagnosis is difficult for parentsLoss of a healthy child

Type 1 Diabetes in Children and AdolescentsKey MessagesSuspicion of diabetes in a child should lead to immediate confirmation of the diagnosis and initiation of treatment to reduce the likelihood of diabetic ketoacidosis (DKA).

Management of pediatric DKA differs from DKA in adults because of the increased risk for cerebral edema. Pediatric protocols should be used.

Children should be referred for diabetes education and ongoing care to a diabetes team with pediatric expertise.Type 1 Diabetes in Children and Adolescents2008 CPG RecommendationsDelivery of CareAll children with diabetes should have access to an experienced pediatric DHC team and specialized care starting at diagnosis [Grade D, Level 4 (1)].

2. Children with new-onset type 1 diabetes who are medically stable should receive their initial education and management in an outpatient setting, providing appropriate personnel and daily telephone consultation service are available in the community [Grade B, Level 1A (2)].

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Network of Ontario Pediatric Diabetes Programs34 NOPDP members28 in Southern Ontario6 in Northern Ontario

5 are academic sites functioning as tertiary diabetes programs

Northern Ontario Programs include:Sioux Lookout, Thunder Bay, SSMarie, Timmins, Sudbury and North Bay.Southern Ontario Pediatric programsEast Ottawa BellevilleKingstonPembrokeTorontoToronto ScarboroughCentral West Kitchener BramptonBurlingtonCambridgeGuelphMississaugaOrangeville

Central SouthHamilton BrantfordSt. CatharinesCentral EastBarrieMarkhamOrilliaMarkhamOrilliaPeterboroughWhitby South WestLondon ChathamOwen SoundSarniaWindsorTertiary Programs in OntarioToronto Hospital for Sick Children Ottawa Childrens Hospital of Eastern OntarioHamilton McMaster Childrens HospitalLondon Childrens Hospital of Western OntarioKingston Hotel Dieu Hospital1Type 1 Diabetes in Children and AdolescentsTo ensure ongoing and adequate metabolic control, pediatric and adult diabetes care services should collaborate to prepare adolescents and young adults for the transition to adult diabetes care [Grade C, Level 3 (100)].Pediatric Care

Adult Care

Shared Care Adult support is required usually up until 16 years of ageSkills can be achieved e.g. injections and blood testingCognitive reasoning is not developed well enough yetE.g. Children might skip an injection to go play or a teen might not inject because of peer pressure

Type 1 Diabetes in Children and AdolescentsChildren with persistently poor diabetes control (e.g.A1C >10%) should be referred to a tertiary pediatric diabetes team and/or mental health professional for a comprehensive interdisciplinary assessment [Grade D, Consensus]. Intensive family and individualized psychological interventions aimed at improving glycemic control should be considered to improve chronically poor metabolic control [Grade A, Level 1A (102,103)].Type 1 Diabetes in Children and AdolescentsGlycemic targets graduated with ageGlycemic targets should be graduated with age (Table 1):Children 7.0% [Grade B, Level 2 (39)].

Type 2 Diabetes in Children and AdolescentsChildren with type 2 diabetes should be screened annually for microvascular complications (nephropathy, neuropathy, retinopathy) beginning at diagnosis of diabetes [Grade D, Level 4 (46)].

10. All children with type 2 diabetes and persistent albuminuria (2 abnormal of 3 samples over a 6- to 12-month period) should be referred to a pediatric nephrologist for assessment of etiology and treatment [Grade D, Consensus].

Type 2 Diabetes in Children and AdolescentsChildren with type 2 diabetes should have a fasting lipid profile measured at diagnosis of diabetes and every 1 to 3 years thereafter as clinically indicated [Grade D, Consensus].

Children with type 2 diabetes should be screened for hypertension beginning at diagnosis of diabetes and at every diabetes-related clinical encounter thereafter (at least biannually) [Grade D, Consensus].

References 2008 Clinical Practice Guidelines for the prevention and treatment of diabetes in Canada Sections: Type 1 Diabetes in Children and Adolescents S150 S161Type 2 Diabetes in Children and Adolescents S 162 S167Guidelines for Managing Sick Days For Children With Type 1 Diabetes , NOPDP Any QuestionsCanadian Diabetes Association 2008 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada, Canadian Journal of Diabetes, Vol 32, Sup 1