Managing diabetes in preschool children
Thread Score:
Page 1 of 1
Thread Actions

9/28/2015 at 1:51:21 PM GMT
Posts: 7
Managing diabetes in preschool children

Dear ISPAD member/friend,

The 2014 ISPAD Practical Consensus Guidelines have been much appreciated, but there was not so much information on the management of diabetes in preschool children included. We therefore created a writing group headed by the first author Frida Sundberg, MD, PhD from Sweden. The other co-authors are Katharine Barnard (USA), Allison Cato (USA), Carine de Beaufort (Luxembourg), Linda DiMeglio (USA), Greg Dooley (USA), Jeff Hitchcock (USA), Vadana Jain (India), Birgit Rami-Merhar (Austria), Carmel Smart (Australia) and myself as editor.

This draft chapter is now downloadable from the forum website. We look forward to a fruitful dicussion on the forum during the 2 coming weeks so that we can get a consensus view. If you are going to our annual meeting in Brisbane, Australia, please take the opportunity to discuss the chapter with one of the co-authors.

Kind regards,

Ragnar Hanas
ISPAD president  



10/14/2015 at 10:14:31 AM GMT
Posts: 3
Hi Ragnar,
Would you consider the following statement to be incorporated into the recommendations to acknowledge the reasons why children with diabetes need special consideration in preschool even though it is discussed at length in the body of the document:
Optimal glycaemic control will give the child/adolescent the best opportunity to concentrate, participate and learn whilst at preschool and school
Cheers
Peter Goss


10/14/2015 at 10:14:37 AM GMT
Posts: 3
Hi Ragnar,
Would you consider the following statement to be incorporated into the recommendations to acknowledge the reasons why children with diabetes need special consideration in preschool even though it is discussed at length in the body of the document:
Optimal glycaemic control will give the child/adolescent the best opportunity to concentrate, participate and learn whilst at preschool and school
Cheers
Peter Goss


10/20/2015 at 4:59:00 PM GMT
Posts: 1
Hi all, thank-you for the opportunity to review the document. Overall I found it very informative, in a logical sequence etc. Just a few comments
1. What is the rating system for the A-E evidence, just remind me where to find it.
2. I would suggest using the term blood glucose consistently, rather than the occasional "blood sugar"
3. I found myself trying to visualize the difference between very young child, young child, child, very young age, young age, toddler. Is there an age range for the different groups, or some other type of "marker" or can the terms be consistent?
4. page 6 the discussion about breast-feeding should emphasize the importance of demand feeding to establish and continue appropriate milk supply and there are other reasons. In Canada the term bottle feeding is discouraged by the experts, they use formula feeding, or actually some prefer breast milk substitute.
5. page 14 what is the reference for the table shown
6 minor point page 1 "at least 1/2 unit dosing" is there anything less available?
7. Some questions about insulin in other countries, are there any other "strengths" available, in Canada it is all U100. How often is insulin diluted, again I have no experience with this as this occurs so rarely and usually an insulin pump will be provided.
Thanks for the opportunity. Bev Harris


10/22/2015 at 7:21:17 PM GMT
Posts: 39
toddler chapter

Ragnar and writing group,

Thank you for this much needed and important chapter!

A few comments:

1) an additional paragraph on the use of remote monitoring with CGM would be useful, even if it is currently available to only a few.  We can hope that this will increase and the families I have who use this like it in this age group.

2) I agree with the advice to split a meal dose for unpredictable eaters in this age group.  You state that the second dose should be given during the meal.  Do you mean after the meal so that you know how much was consumed so that the carbs can be covered?  Or if you mean during the meal for the second dose and if so how do you advise this is done?

3) This month's Diabetes Care has an article on Care in the School Setting (October, 1958-63).  May be useful to reference.

 Again, very nice work!

David Maahs



10/27/2015 at 10:17:07 PM GMT
Comments on the chapter

Thank you for inviting me to review the chapter. I have a few comments/suggestions to consider.

  1. In the section on nutritional needs of the very young child, I wonder if it would be possible to offer some suggestions about how to address parents who are so worried about the blood sugar spikes from food with carbohydrates, that they choose to avoid carbohydrates all together. Similarly, suggestions on how to address parents who only give their children high-fat snacks, such as lunch meats or cheeses instead of fruits or vegetables (again, to avoid carbohydrates) would be a valuable contribution to this section.

  2. In the CGM section, I wonder if something can be added to help parents not over-use the data and then micromanage numbers or over-react to numbers.  I also wonder if you can add some suggestions or advice on how to help children that struggle with issues of skin irritation.

  3. For the psychosocial distress section, please let me know if I can help with editing that section. I have a few concerns. First, it is important to be sure that the readers to not think that measures of depressive symptoms (CDI and CES-D) are measures of quality of life. There are a few QOL measures (Jim Varni’s PedsQL generic and diabetes-specific measures) as well as Maartje DeWit’s Mind-Q measures. Also, considering other areas to assess, such as perceived support (Randi Streisand’s measure), and measures of fear of hypoglycemia may be helpful in this section as well as a discussion of the very many PAID-iterations by a number of different research teams, all of which offer similar measures for assessing diabetes-specific emotional distress.  

  4. In the limited resources section, it may be helpful for clinicians to openly discuss common misperceptions regarding the etiology and treatment of T1D.

  5. I hope these comments are helpful. -Jill



11/1/2015 at 9:44:47 PM GMT
Posts: 2
Dear All, thanks for questions and comments, they are very helpful for revising and improving the document.
This discussion will be open until 1st of December and more comments and questions are most welcome.

The grading system is found in the introduction chapter in the guidelines.

kind regards
Frida Sundberg


11/3/2015 at 3:58:40 PM GMT
Posts: 4
Diabetes in Preschoolers with Chizo's comments
Thank you for work on this chapter.
Would you consider including in your recommendation: Clinicians need to be aware of the overwhelming sense of responsibility and worry which parents with toddlers with diabetes feel. Many exhibit the so called 'constant vigilance'. Some may end up isolated as they are afraid of others helping in looking after their child.
In the page 9........I have made some changes to the text which I have tracked and will send as a word document
regards
Chizo Agwu


Last edited Tuesday, November 3, 2015
12/12/2015 at 12:33:32 PM GMT
Posts: 2
Dear All, first: thank you for contributing with your important comments, questions and suggestions.
The plan is to finalize the document before the 1st of January.
Best wishes,
Frida Sundberg


Contact Us

ISPAD Executive Office
c/o K.I.T. Group GmbH
Association & Conference Management
Kurfürstendamm 71
10709 Berlin, Germany










Join ISPAD

Click the link below to join the Society!


Join Today!










Phone: +49 (0)30 24603-210
Fax: +49 (0)30 24603-200
Email: secretariat@ispad.or
g










Privacy Policy
Terms of Service
Legal Notice    

Disclaimer



































 © 2018 International Society for Pediatric and Adolescent Diabetes (ISPAD)






Association Management Software Powered by YourMembership  ::  Legal