CDiC Programme Introduction

Programme 1 2 3 4 5 6 7 8 Introduction Coping with diabetes Chronic care plan Routine care Emergency Care of Diabetes Diagnosing Diabetes in Childhood 7 Diabetes and the growing child 8 Clinic organisation

Introduction

Diagnosing diabetes in childhood

Emergency care of diabetes

Routine care

Chronic care plan

Coping with diabetes

Diabetes and the growing child

Clinic organisation

Introduction

Diabetes in Childhood Killer disease, especially in childhood Relatively rare Subtle symptoms Missed diagnoses could be decreased Effective early treatment can reduce morbidity and also mortality Diabetes is a killer disease. This is an even bigger problem in children with diabetes. This condition is relatively rare in childhood and has very subtle symptoms. Therefore, this condition is often not diagnosed early and many children are finally diagnosed when very sick in a clinical state called diabetic ketoacidosis. Knowing the symptoms of diabetes can mean that the number of children who are not diagnosed early could be decreased. Effective treatment of diabetes and DKA can reduce the number of children who die from diabetes as many die during treatment of DKA.

Diabetes in Childhood Increasing prevalence (worldwide) Increasing awareness Improved survival of children with diabetes Improvements in child care and reductions in pneumonia, diarrhoea, malnutrition, TB and HIV You will see children with diabetes - if you look for them! There is an increasing number of children who have diabetes across the entire world. There is also an increasing awareness of the symptoms and signs of diabetes. With improvements in care of children with diabetes more children with diabetes survive. As our health care systems get better and as child health care improves we can expect reductions in deaths from pneumonia, diarrhoea, malnutrition, tuberculosis and HIV infection. Taken together, these factors mean that you are more likely to be seeing children with diabetes. It therefore becomes important that you understand and recognize diabetes in children in your clinics.

Why a programme for children? Type 1 diabetes starts in childhood Early diagnosis and treatment crucial Presentation in DKA is very common Only effective treatment is insulin and correcting salt and water imbalances Different from adults Growth, changing weight, changing life styles Complex illness Long term complications – deadly but preventable Needs good support system Patient, parents, teachers, health care workers, friends Type 1 diabetes most commonly starts in childhood. Children often present in diabetic ketoacidosis. DKA is a life threatening situation. The only effective treatment of diabetes is insulin. It is therefore crucial that the diagnosis is made as early as possible and treatment started as soon after diagnosis as possible. Children are different from adults: they are constantly growing, weight increases with age and their lifestyles change as they get older. As they develop they are able to understand more and help with their own care, but are frequently dependent on their parents and others for their health care. Diabetes is a complex condition and has serious long term complications. The risk of complications are increased when care is poor. As a result the child with diabetes requires a good support system that should include the patient, his/her parents, teachers, health care workers at all levels of the health care system, friends and the extended family. These factors make it essential to have a dedicated programme for children with diabetes

CDiC programme components 1 Infrastructure and equipment Learnings & outcome 6 Training & education of HCPs 2 5 Diabetes registry, monitoring and control 3 Free insulin 4 Patient education

CDiC Programme The CDiC programme is a Novo Nordisk initiative in partnership with: World Diabetes Foundation Roche International Society for Pediatric and Adolescent Diabetes (ISPAD) Insulution Goal = improving the care of the child and adolescent with diabetes Based on UN Resolution on Diabetes ISPAD Declaration of Kos The CDiC programme is a Novo Nordisk initiative in partnership with the World Diabetes Foundation, Roche, Insulution and the International Society for Paediatric and Adolescent Diabetes; an organisation for professionals with a focus on diabetes in childhood. The goal of this programmes is to improve the care of the child and adolescent with diabetes. This goal is in keeping with the UN declaration on diabetes and the ISPAD Declaration of Kos, which are included in the preface of your manual.

Country organisation Centres of excellence Tertiary centres Referral centres Regional centres Primary care centres People responsible for the programme This slide needs to be adapted to describe the health care system in each country and the various levels of responsibility for the CDiC programme.

Echelons of care Echelon 1 Primary care facilities Hospitals where children with diabetes are rarely seen Goals: Diagnosis of diabetes – how to think about diagnosis Good routines for referral to next level for DKA treatment Recognise the role of insulin Understand principles and priorities of treating children with diabetes Understand storage and use of insulin Assist with continuing care Local support of the child with diabetes These slides are to describe the different echelons of care within the programme.

Echelons of care Echelon 1 Echelon 2 Have basic exposure to diagnosis and treatment of diabetes including Diabetic Ketoacidosis (DKA) Have insulin and diabetes supplies on site Know how to start treatment with insulin Recognize and start basic measures for DKA Distribute insulin and diabetes supplies to patients Supervise care prescribed by an echelon 3 facility These slides are to describe the different echelons of care within the programme.

Echelons of care Echelon 1 Echelon 2 Echelon 3 District/regional hospital with designated paediatrician specifically trained in diabetes care Definitive DKA management Holistic long-term follow-up and care of child with diabetes Supply depot for insulin and supplies Data collection centre Training centre for echelons 1-2 Basic laboratory support These slides are to describe the different echelons of care within the programme.

Echelons of care Echelon 1 Echelon 2 Echelon 3 Echelon 4 Referral centre for difficult cases Multidisciplinary paediatric care Screening for complications Database administration Training centre for echelons 1-3 Defined collaboration with ISPAD colleagues/mentors These slides are to describe the different echelons of care within the programme.

Goals for today Recognise the symptoms of diabetes Be able to make a diagnosis of diabetes Understand pitfalls and other diagnoses that are mistaken Refer patient to next echelon for treatment Initiate simple treatment of DKA Help co-manage patient with echelon 3-4 unit

Questions Take questions

novo nordisk changing diabetes - Outro Changing Diabetes® and the Apis bull logo are registered trademarks of Novo Nordisk A/S 24 novo nordisk changing diabetes - Outro