Diabetes in writingThe Royal College of GPs (RCGP) has cautiously welcomed a new Quality Standard by NICE on the diagnosis of diabetes in children, saying the move to merge the diagnosis of type 1 and type 2 diabetes removes the “the not insignificant challenge” of making a definitive diagnosis, but arguing for better joined-up working in the health service to make such a guideline workable.

Dr Stephen Lawrence, Diabetes Lead for the RCGP, said: “Diabetes – both type 1 and type 2 – are debilitating, long-term conditions for patients, and can lead to other serious conditions, such as cardiovascular, eye and kidney disease, and the prevalence of both is increasing in patients of all ages. 

“When we spot signs in children, it’s a priority for GPs to act quickly in order to give our young patients the best chance of maintaining a healthy, high quality of life for as long as possible.

“The aspirations from NICE are admirable, and a welcome addition to existing guidance – particularly for type 1 diabetes, having our patients that we suspect of having diabetes in front of a specialist within 24 hours is something that the College has called for. 

“Whilst some colleagues may question the amalgamation of children with type 1 and type 2 diabetes, this does remove the not insignificant challenge and potential delay in making a definitive diagnosis in a child presenting with more equivocal signs of the disease. 

“However, it is essential that general practice, and onwards services, are resourced sufficiently in order for the new NICE recommendations to become a reality. We also need better joined-up working across the health service, so that specialist services don’t become overloaded with any increase in demand, and that GPs don’t bear the brunt of criticism for simply following clinical guidance in the best interests of our patients.”

The Quality Standard covers the diagnosis and management of type 1 and type 2 diabetes in children and young people aged under 18. It does not cover care for children and young people with other forms of diabetes mellitus, such as monogenic diabetes or cystic fibrosis-related diabetes. 

NICE Quality Standards describe high-priority areas for quality improvement in a defined care or service area. Each standard consists of a prioritised set of specific, concise and measurable statements. They draw on existing guidance, which provides an underpinning, comprehensive set of recommendations, and are designed to support the measurement of improvement.

It includes six quality statements: 

Statement 1. Children and young people presenting in primary care with suspected diabetes are referred to and seen by a multidisciplinary paediatric diabetes team on the same day. 

Statement 2. Children and young people with type 1 or type 2 diabetes are offered a programme of diabetes education from diagnosis that is updated at least annually.

Statement 3. Children and young people with type 1 diabetes are offered intensive insulin therapy and level 3 carbohydrate‑counting education at diagnosis. 

Statement 4. Children and young people with type 1 diabetes who have frequent severe hypoglycaemia are offered ongoing real‑time continuous glucose monitoring with alarms.

Statement 5. Children and young people with type 1 diabetes are offered blood ketone testing strips and a blood ketone meter.

Statement 6. Children and young people with type 1 or type 2 diabetes are offered access to mental health professionals with an understanding of diabetes. 

For more information on the Quality Standard visit https://www.nice.org.uk/guidance/qs125