1. CDiC Programme
Introduction

2. 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

3. Introduction

4. Diagnosing diabetes in childhood

5. Emergency care of diabetes

6. Routine care

7. Chronic care plan

8. Coping with diabetes

9. Diabetes and the growing child

10. Clinic organisation

11. Introduction

12. 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.

13. 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.

14. 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

15. CDiC programme components1
Infrastructure
and equipment
Learnings &
outcome 6
Training &
education of HCPs 2 5
Diabetes registry, monitoring and control 3
Free insulin 4
Patient education

16. 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.

17. 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.

18. 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.

19. 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.

20. 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.

21. 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.

22. 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

23. Questions
Take questions

24. 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