Nice | Type 2 diabetes in children and young people

This is the other half of the guideline on diabetes in children and young people, recently published by NICE.  I would suggest reading my blog on type 1 diabetes in children first.

Again, I haven't covered everything, just the bits that are particularly useful for us, or things that I wasn't aware of, or thought were a change in practice.

Education

This is very important and each time a child with type 2 diabetes presents, you should be talking about the importance of annual monitoring (eg BP, ACR etc) and also be advising on the benefits of healthy eating (eg lowering blood sugars, reducing weight and reducing CV risk).

Interestingly they advise a 'continuing programme of education', rather than advising a particular programme, like DESMOND.

Other aspects of health

  • Flu jab should be advised annually.
  • Pneumococcal jab should be given if they are on insulin or on medication to lower glucose.
  • Psychological. As for type 1 diabetes, this can be very important. Screen for problems.

Metformin

Should be offered from diagnosis (presumably regardless of HbA1c levels etc).

HbA1c

  • Measure every 3m.
  • Target of 48 (6.5), but this may need to be modified for the individual.

Follow Up

  • Education as above (offer dietician support if needed)
  • Dental Check - annually
  • Eye check - every 2 years
  • Height / Weight / BMI and plot on chart
  • Hypertension (from diagnosis) - If over 95th centile for age / sex, do 24 hr monitoring
  • Lipids (from diagnosis) - repeat if dyslipidaemia is found
  • Diabetic retinopathy (from 12, but consider earlier referral if suboptimal control)
  • ACR from diagnosis (as for type 1)

Louise Hudman

I'm a freelance GP locum in Winchester & Southampton locum chambers, and Pallant Medical Chambers Clinical Guidelines Lead Partner.

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