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The multidisciplinary diabetes team is the cornerstone of care
Type 1 diabetes is the third most common chronic disorder in childhood, after asthma and cerebral palsy. It is life threatening, life long, and invades the lives of children both day and night without respite. It is reported to reduce lifespan on average by 25%.1 Its incidence is continuing to rise across the country and is presenting at an earlier age.2,3 The prevalence shows that in a district population of 250 000 there will be 75 young people with this condition.
The standards of paediatric diabetes services provided for these children have been questioned recently,4 and in the past have been shown to be inadequate,5 resulting in suboptimal metabolic control. There is indisputable evidence that the long term complications of diabetes are related to preceding levels of glycated haemoglobin (HbA1C) with an exponential rise occurring with levels >8.5%.6 In many young people with diabetes there is poor compliance with insulin regimens,7 mortality is significantly increased,8 and the microvascular complications of retinopathy, nephropathy, and neuropathy are commonly reported by early adulthood.9
ADVISED SERVICE PROVISION
National guidelines for paediatric diabetes care were published in 1995, based on the St Vincent Declaration,10 which were endorsed by the Royal College of Paediatrics and Child Health. These are incorporated in the recently published Standards of the Diabetes National Service Framework (NSF).11 They state that children and adolescents with diabetes should be managed by an appropriately resourced and trained paediatric multidisciplinary team consisting of a paediatrician with a special interest in diabetes, a paediatric diabetes specialist nurse, a paediatric dietitian with expertise in diabetes, a senior paediatric ward nurse with experience in diabetes, and easy access to services in psychology, psychiatry, podiatry, and ophthalmology.
In addition they should …