Approach to the Young child & Parent with Child with DM Best Structure for Continued Care

Transcription

1 Approach to the Young child & Parent with Child with DM Best Structure for Continued Care M.S. Limbe MD Paediatric Endcocrinologist Aga Khan University Hospital, Nairobi

2 Approach to the Young Child & Parent with Child with DM Challenges faced at diagnosis DM in children is usually Type 1 (Insulin-dependent) Difficulty in convincing parents Breaking news of a major, chronic illness in a young child Challenge of explaining to the young child why they need to receive so many injections Overcoming needle phobia in some children Diet plan to enable growth without compromising BG control Need to facilitate uninterrupted learning, while ensuring optimum BG control

3 What are the current recommendations? BG target for children and young people: 4-7 pre meals and 5-9 after meals Choice of insulin/regimen: Basal-bolus insulin regimen; CSII as an alternative Analogue or human insulin? Left to prescriber & pt All pts should be offered basal-bolus rather than twice daily mixed insulins Pts with newly diagnosed diabetes should not be offered any choice other than basal-bolus. Rapid-acting analogues are the choice for meal times

4 Recommendations ctd Much of new guidance is on importance of primary care Many of the new recommendations reflect recent changes in clinical practice: 1. Structured education for all pts 2. Annual check of thyroid function 3. Use of blood ketone testing rather than urine testing as part of the sick day rules. 4. Low glycaemic index diet for children and young people with DM although not for adults. 5. Tighter glycemic control HBA1c 6.5% from previous 7.5% but hypo risks are real

5 Approach Considerations All children with T1DM require insulin therapy (Insulin availability+ affordability) Regular blood glucose monitoring is essential (glucometer, glucose strips) Blood ketone testing recommended when needed (equipment to measure blood ketones) A well-organized diabetes care team (multidisciplinary team) Shared appointments

6 Items Needed for Management of Type 1 Diabetes Mellitus

7 Self Blood Glucose Monitoring Ideally 4 blood glucose measurements per day, but

8 What happens to sugar in our blood when we eat?

9 Vial and syringe Insulin Delivery Methods Insulin pen & Cartridge Injecting insulin with a pen Insulin Pump Insulin Pump

10 What is the best structure for continued care? Considerable new approaches to providing modern diabetes care in 21 st century Evolving role of diabetes care providers collaboratively working with pts & families toward the goals of achieving optimal clinical and psychosocial outcomes for individuals living with diabetes. Advances in monitoring, treatment and technology have been complemented by trends toward multidisciplinary patient-centered care

11 The Evolving Model of Diabetes Care Extends far beyond adjustment of insulin regimens. Effective integration of patient-centered strategies: shared-decision making motivational interviewing techniques shared medical appointments multidisciplinary team collaboration Aim of this? To reach glycemic targets and improve patients quality of life.

12 So, What is the best structure for continued care for child with diabetes mellitus? Aim: To achieve optimal clinical & psychological outcomes for individuals living with diabetes Diabetes care providers collaborating with pts and families Advances in monitoring, treatment and technology Patient-centred care by multidisciplinary health-care professionals Effective integration of strategies, shared decisionmaking and appointments Effective diabetes education and support that help to intergrate diabetes care with other daily activities

13 Approaches to Patient-Centered Care

14 Stucture for continued care Multidisciplinary Team approach Child (Patient) Family Physician Diabetes educator Nurse Dietician/nutritionist Counselling psychologist School teacher School Nurse

15 Local experience Key issues in Childhood & Type 1 DM in Kenya- Local challenges: 1. Diagnosis: Awareness; acceptance Antibodies 2. Resources: Human Material: lab support, glucometers, glucose strips insulin. Donor dependence and its risks! 3. Food/nutrition: Availability/compliance 4. Adolescents and Diabetes

16 Measures taken to solve some of the challenges 1. Changing Diabetes In Children (CDIC) Programme A worldwide programme funded by Novo Nordisk Kenya, one of 7 African countries participating Through Minsistry of health: Hubs and Spokes Personnel trained and supervised by Paed endo group Pts recruited upto age 18, supported upto 23 yrs. Receives: Insulin (Mixtard) by Novo, glucometer from Roche and 3-4 glucose strips per day HbA1 machine to the hub

17 An international group 2. Life for a Child Supports children with insulin, glucometers and strips

18 Summary Best structure for ongoing care of children with DM is a multidisciplinary approach Many challenges face provision of optimum, both in diagnosing and management of T1DM Diabetes is an expensive condition, requires appropriate financial allocation, so far has not been prioritized by government. Overreliance on donors poses a threat to sustainability and continuity of care

19 Thank you For Your Attention