The nurse's role in childhood diabetes
Daniel Allen summarises the latest guidance on childhood diabetes.
Daniel Allen summarises the latest guidance on childhood diabetes
The National Institute for Health and Care Excellence (NICE) has published a quality standard on diabetes in children and young people. NICE quality standards describe high-priority areas for improvement and consist of specific, measurable statements designed to achieve better care.
Diabetes is becoming more common in the UK. The latest National Paediatric Diabetes Audit says the number of children and young people cared for in paediatric diabetes units is rising at 4% per year. In 2014-15, the prevalence in England and Wales of type 1 diabetes in those aged 15 and under was 192 per 100,000 of the general population, with slightly more males affected than females. The impact of the disease is far-reaching: as well as having long-term implications for physical health, diabetes can affect school, personal and family life as well.
A NICE guideline on diagnosing and managing diabetes in children and young people was published last year. It recommended strict blood glucose monitoring as a means of improving care and reducing the impact of the condition.
The six quality statements in the new NICE standard relate to same-day referral, education and information, intensive insulin therapy and carbohydrate counting, glucose monitoring, blood ketone monitoring and access to mental health professionals with an understanding of diabetes. The standard covers type 1 and type 2 diabetes. NICE says it is expected to lead to improvements in a number of outcomes, including prompt diagnosis, complications, quality of life and life expectancy.
Central to achieving those outcomes is quicker referral. The quality standard says children and young people whose diagnosis and care are delayed are at greater risk of developing diabetic ketoacidosis, which is life-threatening but preventable. For that reason, those presenting in primary care with suspected diabetes should be referred to and seen by a multidisciplinary paediatric diabetes team on the same day. ‘Suspected diabetes’ means one or more of these symptoms – increased thirst, increased urination, excessive tiredness and/or recent unexplained weight loss.
Equality issues were an important consideration in the development of the standard, NICE says. Treatment, care and support must be culturally appropriate. And information given should be accessible to those who do not read or speak English and to those with additional needs such as learning disabilities.
How you can help your patient
The diabetes standard is clear about what each of the six quality statements means for health professionals, especially those working in paediatric diabetes teams. Nurses in such teams have a clear role in tailoring a programme of diabetes education to each individual’s needs and learning styles, and ensuring it is updated annually.
For staff outside specialist diabetes teams, awareness is key. With the prevalence of diabetes increasing, it is likely to be encountered in any service that offers paediatric support or treatment. So, for example, primary care nurses should be attuned to the possibility of diabetes in presenting children and young people, and should facilitate rapid referral.
Similarly, emergency department nurses must be alert to diabetes playing a part in medical emergencies. And the quality statement on access to psychological support outlines a role for mental health nurses who have a clear understanding of the problems that diabetes can cause and interventions to alleviate them. ‘The mental health professional should be one of the main members of the diabetes team,’ the quality standard says.
Nurses involved in service development can use the template on the NICE website to assess, improve and demonstrate the quality of the paediatric diabetes care they provide.
Daniel Allen is a freelance health journalist
Jo Dalton, diabetes specialist nurse – transition, Poole Hospital, Dorset, and NICE quality standard adviser:
‘Diabetes is demanding. This standard is about putting key things in place to improve services, and the first is making sure people are diagnosed in a timely fashion – if you suspect a child or young person may have type 1 diabetes, send them to a children’s diabetes team the same day.
‘The target group for the standard is across the board: practice nurses, so we diagnose quickly; emergency department nurses, because they see patients with a new diagnosis or who are struggling with their diabetes; and paediatric nurses, on wards, who will be involved in education around a new diagnosis.
‘The take-away message is, take an interest in diabetes. And to find out more, contact your local paediatric diabetes team.’
Find out more
NICE guidelines and standards
Royal College of Paediatrics and Child Health
Diabetes UK list of resources