NICE quality standard advises children and young people with suspected diabetes be seen by a specialist immediately

14 Jul 2016

When a GP suspects a child or young person has diabetes, they should immediately be sent to hospital and seen the same day by a specialist, under new NICE quality standards.

Immediate referral for suspected diabetes is part of the care that should be provided in diagnosing and managing both type 1 and type 2 diabetes in children and young people, says the new quality standard published today by NICE (Thursday 14 July).

Prompt diagnosis is vital because diabetes is a long-term condition that has a serious impact on people who live with it. Around 26, 400 children and young people have type 1 diabetes and 500 have type 2 diabetes.

If left untreated it can cause tissue damage, resulting in blindness, kidney failure, foot ulcers which can lead to amputation, and also premature heart disease, stroke and death.

Type 1 diabetes occurs when the cells that normally make insulin – the hormone which controls the amount of glucose (sugar) in blood – are destroyed, and the loss of insulin results in high levels of glucose in the blood. A person with type 2 diabetes has too much glucose in their blood either because their body doesn’t produce enough insulin or their body doesn’t use insulin effectively.

The new quality standard states that children and young people with suspected diabetes should be referred immediately by their GP and seen on the same day by a multidisciplinary paediatric diabetes team.

It also sets out that children and young people with type 1 diabetes should be offered intensive insulin therapy to help them maintain near normal blood glucose levels.

In addition, diabetes management should include education, support and access to psychological services.

Professor Gill Leng, deputy chief executive of NICE, said: "Type 1 and type 2 diabetes can be a very difficult disease to manage for children and young people and their families, with a huge impact on their daily lives.

"NICE’s guidance on children and young people with diabetes was the first to recommend attempting to reach near normal blood glucose levels. This means that the child or young person will need multiple daily injections or insulin pump therapy. This is along with carbohydrate counting, which means matching the amount of insulin with the amount of carbohydrate eaten.

"We know that reaching and maintaining near normal blood glucose levels is difficult, but it reduces the tissue damage caused by high blood glucose, and so may avoid the long-term health problems caused by diabetes.

"Diabetes teams should provide all the help that children and young people need to stay as healthy as possible, including psychological support through access to mental health professionals with an understanding of diabetes."

Helen Wills, whose 11 year old daughter has type 1 diabetes, said: "Managing diabetes – especially in a growing child – is exhausting, confusing, and relentless. It’s also a huge worry for a parent, so having a team that can fully support all our needs and questions is essential. We cope because the team makes sure we have access to all the checks she needs, and teach us how to really maximise the technology we use – her insulin pump and continuous glucose monitor. Without these, and access to her hospital team whenever we need it, we wouldn’t be able to achieve the recommended HbA1c. We rely on the NICE guidelines and standards to make sure we have all the tools we need to do the best job we can, and to help her live as normal a life as possible."

Michael Connellan, spokesperson for JDRF (The Juvenile Diabetes Research Foundation), said: "Type 1 diabetes is a lifelong condition that can have a big impact on lives, including those of children and young people. It is vital that everyone who lives with type 1 diabetes is provided with the right treatment, support, education and access to diabetes technologies, thus helping them best manage their condition."

For more information call Dr Tonya Gillis at the NICE press office on 0300 323 0142, or out of hours on 07500 605 228.