Table 8.1Suggested audit criteria

RecommendationCriterionExceptionDefinition of terms
Children and young people with type 1 diabetes should be offered an ongoing integrated package of care care by a multidisciplinary paediatric diabetes care team. To optimise the effectiveness of care and reduce the risk of complications, the diabetes care team should include members with appropriate training in clinical, educational, dietetic, lifestyle, mental health and foot care aspects of diabetes for children and young peoplea. A paediatric team providing care for a child or young person with type 1 diabetes should include members with specialist training in clinical, educational, dietetic, lifestyle, mental health and foot care aspects of diabetes appropriate for children and young peopleNone
At the time of diagnosis, children and young people with type 1 diabetes should be offered home-based or inpatient management according to clinical need, family circumstances and wishes, and residential proximity to inpatient services. Home-based care with support from the local paediatric diabetes care team (including 24-hour telephone access to advice) is safe and as effective as inpatient initial managementa. A newly diagnosed child or young person with type 1 diabetes has an offer of home-based or inpatient initial management documented in their notesChildren and young people with diabetic ketoacidosis
Children and young people with social or emotional difficulties
Children under the age of 2 years
Children and young people who live a long way from inpatient facilities
Initial – treatment received starting from diagnosis continuing for the first 2 weeks
Social and emotional difficulties – a situation judged by the paediatric diabetes care team to indicate that home-based or outpatient initial management would not be in the best interests of the child or young person or their family
b. A child or young person with newly diagnosed type 1 diabetes who receives home-based or inpatient initial management should have it documented in their notesNone
Children and young people with type 1 diabetes and their families should be offered timely and ongoing opportunities to access information about the development, management and effects of type 1 diabetes. The information provided should be accurate and consistent and it should support informed decision makinga. A child or young person with type 1 diabetes has it documented in their notes that an offer of timely and ongoing opportunities to access information about development, management and effects of type 1 diabetes in relation to care has been made. The information should be accurate and consistent and it should support informed decision makingNone
Children and young people with type 1 diabetes and their families should be informed that the target for long-term glycaemic control is an HbA1c level of less than 7.5% without frequent disabling hypoglycaemia and that their care package should be designed to attempt to achieve thisa. A child or young person with type 1 diabetes has it documented in their notes that they have been informed that the target for long-term glycaemic control is an HbA1c level of less than 7.5% without frequent disabling hypoglycaemiaNoneHbA1c is measured with a DCCT-standardised assay
b. A child or young person with type 1 diabetes has it documented in their notes that they have been offered testing of their HbA1c levels two to four times per yearNone
c. A child or young person with type 1 diabetes has an HbA1c level of less than 7.5% without frequent disabling hypoglycaemiaChildren and young people with haemoglobinopathies or abnormalities of erythrocyte turnoverHaemoglobinopathies that interfere with glycated haemoglobin measurement – see www.missouri.edu/~diabetes/ngsp/factors.htm
d. A child or young person with type 1 diabetes has an HbA1c level of less than 7.5% with frequent disabling hypoglycaemiaNone
Children and young people with diabetic ketoacidosis should be treated according to the guidelines published by the British Society for Paediatric Endocrinology and Diabetesa. A child or young person with diabetic ketoacidosis should be treated according to the guidelines published by the British Society for Paediatric Endocrinology and DiabetesNone
b. A child or young person with diabetic ketoacidosis recovers without complicationsNoneComplications – death, cerebral oedema with permanent neurological disability
Children and young people with type 1 diabetes should be offered screening for:
  • coeliac disease at diagnosis and at least every 3 years thereafter until transfer to adult services*
  • thyroid disease at diagnosis and annually thereafter until transfer to adult services
  • retinopathy annually from the age of 12 years
  • microalbuminuria annually from the age of 12 years
  • blood pressure annually from the age of 12 years.
a. A child or young person with type 1 diabetes has it documented in their notes that an offer of a coeliac disease test at diagnosis and at least every three years has been madeChildren and young people who are known to have coeliac disease
b. A child or young person with type 1 diabetes has it documented in their notes that an offer of a thyroid disease test at diagnosis and every year subsequently has been madeChildren and young people who are known to have thyroid disease
c. A child or young person with type 1 diabetes has it documented in their notes that an offer of a retinopathy test every year from the age of 12 years, has been madeNone
d. A child or young person with type 1 diabetes has it documented in their notes that an offer of a microalbuminuria test every year from the age of 12 years has been madeNone
e. A child or young person with type 1 diabetes has it documented in their notes that an offer of blood pressure measurement every year from the age of 12 years has been madeNone
Children and young people with type 1 diabetes should be offered timely and ongoing access to mental health professionals because they may experience psychological disturbances (such as anxiety, depression, behavioural and conduct disorders and family conflict) that can impact on the management of diabetes and wellbeinga. A child or young person with type 1 diabetes or their family referred to a mental health specialist should be seen as soon as possibleNone
*

We have updated our guidance on screening for other conditions in children and young people with type 1 diabetes; we have removed the recommendation to re -test for coeliac disease at least every 3 years after diagnosis. This update follows the development of ‘Coeliac disease: recognition and assessment of coeliac disease’ (NICE clinical guideline 86, 2009).

We have updated our guidance on screening for other conditions in children and young people with type 1 diabetes; we have removed the recommendation to re -test for coeliac disease at least every 3 years after diagnosis. This update follows the development of ‘Coeliac disease: recognition and assessment of coeliac disease’ (NICE clinical guideline 86, 2009).

From: 8, Auditable standards

Cover of Type 1 Diabetes
Type 1 Diabetes: Diagnosis and Management of Type 1 Diabetes in Children and Young People.
NICE Clinical Guidelines, No. 15.2.
National Collaborating Centre for Women's and Children's Health (UK).
London: RCOG Press; 2004 Sep.
Copyright © 2004, National Collaborating Centre for Women’s and Children’s Health.

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