Introduction

We as pediatric diabetes specialists believe that the needs of children and adolescents with diabetes and their families are very special and are different from those of adults. This belief is enshrined in both the International Diabetes Federation (IDF) philosophy (click here) and in the first International Society for Pediatric and Adolescent Diabetes (ISPAD) Consensus Guidelines published in 1995. In contrast, the IDF Type 1 (Adult) Diabetes Desktop Guide, 1998 (ISBN 0 7017 0080 7) shows distinctive differences from the pediatric guidelines.

The 1995 ISPAD Consensus Guidelines have been translated into many different languages and formed the basis of the handbook produced by the Australian Paediatric Endocrine Group (APEG, 1996, ISBN 0 646 28302 2), which remains a rich source of information and guidance.

These publications acknowledge the fact that children and families require an holistic approach to their care and have helped to ‘pave the way for practical, flexible, age-appropriate management, to ensure the well-being of the child and adolescent, who should be able to participate in all normal life activities at home, at school and in employment, and to minimize psychological and long-term complications’ (Laron, ISPAD Consensus Guidelines, 1995).

These revised guidelines for the new millennium are more comprehensive, contain new sections and place education at the center of clinical management.

Education provides not only a knowledge base but also when it is delivered in a style which is patient-centered and appropriate for the age and maturity of the young person and the culture of the family, it becomes the vehicle for optimal self-management, the key to success.

Clinical guidelines are defined as ‘systematically developed statements to assist practitioners and patients in decision-making on the most appropriate health care for specific clinical circumstances’. Childhood diabetes is a condition for which clinical guidelines are entirely appropriate because there are

huge variations both worldwide and within countries in the acceptance of diabetes as a major chronic disease of childhood
massive inequalities in the provision of resources
major differences in management strategies
wide discrepancies in outcomes and cost-effectiveness.

The guidelines are based on a wide consensus of clinical practice. They were drafted by international writing teams, modified by experts in different specialties from many countries, debated at the annual ISPAD meeting in 1999, and were reviewed by members via the internet and the ISPAD website.

We hope therefore that the guidelines will be widely consulted and will be used to

improve awareness among governments, state health care providers and the general public of the serious long-term implications of poorly managed diabetes and of the essential resources needed for optimal care
assist individual care givers in managing children and adolescents with diabetes in a prompt, safe, consistent, equitable, standardized manner in accordance with the current views of experts in the field.

With regard to the contentious issue of an evidence base for the guidelines, it was agreed by consensus that references should not be included nor should we attempt to classify the levels of scientific evidence for the following reasons

the guidelines are essentially clinical and are based on consensus opinion
evidence at the higher levels of controlled trials was either not available or not easily applicable to many aspects of childhood diabetes

Nevertheless, in support of the recommendations and statements in the guidelines we intend to publish as soon as possible referenced resource papers.

These guidelines are not strict protocols nor are they the final word. They will evolve as new information becomes available. They will be viewed from many different perspectives and interpreted in various ways not only in different countries but also in different centers within individual countries.

We sincerely hope that the guidelines will improve the understanding and clinical management of diabetes in young people by all those who have the privilege and shared responsibility of caring for children and adolescents with diabetes.

Peter G.F. Swift
Editor in Chief, ISPAD Consensus Guidelines 2000

Practical editorial points

Throughout the text we have used ‘international English’
Whenever the words ‘child’ or ‘children’ are used they most often also mean ‘and adolescents’
Whenever the word ‘parent’ is used it most often also means ‘all close care givers’
DCCT = Diabetes Control and Complications Trial
BG = whole blood glucose level
Units of measurement of BG = mmol/l
When 1 mmol/l = 18 mg/100 ml or 18 mg/dl
HbA_1c means the ‘c’ fraction of glycated hemoglobin HbA₁