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Outpatient management / ambulatory care
Essential members of the multidisciplinary diabetes care team
- Pediatrician specializing in diabetes/endocrinology (or a physician with a special interest in childhood and adolescent diabetes)
- Diabetes specialist nurse and/or diabetes educator
- Dietician
Other health care professionals should be part of the specialist team, or at least there should be easy access to
- Psychologist/psychiatrist/counselor trained in pediatrics and with some knowledge of childhood diabetes
- Pediatric social worker
- Chiropodist/podiatrist with knowledge of childhood diabetes
These recommendations will be impossible in areas of low population density or where childhood diabetes rarely occurs. In these circumstances, and where the number of children with diabetes is small, care is likely to be provided by a locally based pediatrician/physician. These practitioners should have ready access to facilities and advice provided by the
diabetes care team in regional centers of excellence. Where practical the annual review might best be performed in the regional center
General aims of the diabetes care team should be to provide
- Expert practical guidance and skill training
- Consistent and repeated educational advice
- An understanding of, and support for, the psychosocial needs of the family
Diabetes is a condition requiring skilled self-management in the home and local environment. Therefore the diabetes care team should have the resources to develop strong links, clear communication and common working practices with
- The child and family at home
- The young person at school/college
- Primary health care providers
- Other pediatricians and health care providers in areas of low population density
The organization of the diabetes care team, its size and situation will depend on geographical and demographic characteristics
- The teams from district or regional centers might organize outreach clinics when there are difficulties for children and families travelling to the regional centers
The specific aims of the diabetes care team should be to provide
- Specialized hospital medical care
- Expert comprehensive ambulatory care of diabetes and associated pediatric conditions
- Expert advice on issues related to diabetes such as exercise, travel and sickness
- Screening for complications
- Emergency telephone or other support 24 hours a day
Generally accepted good clinical practice for the successful management of children and adolescents
At onset
- Provision of easy access (24-h a day) to diabetes care team for rapid diagnosis and initiation of treatment
- Availability of accepted written protocols for management of DKA and other types of presentation of childhood diabetes
- Provision of practical guidance at diagnosis, including dietary management
- Domiciliary/outpatient/ambulatory management of children at the time of diagnosis is possible in some centers but can only be recommended when 24-h access to senior experienced members of the diabetes care team is available
The importance of providing ‘a good start’ with confident, clear, positive messages, support and advice cannot be overemphasized
The first 6 months
- Frequent contact with the diabetes care team is necessary to help in managing the changing requirements of diabetes in its early phases
- Contact may be by frequent clinic appointments, home visits, telephone or other methods
Follow-up consultations
- It is common practice for children and adolescents to be reviewed in outpatient clinics at least three or four times a year, or more if particular difficulties in managing diabetes are recognized
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