The delivery of ambulatory diabetes care to children and adolescents with diabetes

This article is a chapter in the ISPAD Clinical Practice Consensus Guidelines 2014 Compendium.The complete set of guidelines can be found for free download at www.ispad.org.The evidence grading system used in the ISPAD Guidelines is the same as that used by the American Diabetes Association.See page 3 (the Introduction in Pediatric Diabetes 2014; 15 (Suppl.20): 1-3). Ambulatory careimmediate access to a Diabetes Care Team is not possible (B, E). Processes of diabetes care should include:• A visit at least every 3 months for a re-evaluation of diabetes management and review of home management records, as well as evaluation of growth, development, and general health.• An annual visit with assessment and review of dietary knowledge, self-management skills and behaviors, and psychosocial needs, screening for comorbidities and risk factors for long-term complications, identification of barriers to care, and educational updates.• A planned transition to adult diabetes care which improves outcomes and helps to ensure continuity of care during this critical time (4, 5) (B, E).The age of transfer to an adult clinic varies according to individual and local circumstances.• Culturally sensitive communication, counseling, and encouragement for altering preconceptions or negative and unhealthful beliefs about diabetes (6).• Assistance to access care.Care is facilitated by electronic or paper tools such as clinic information sheets (E) to track each child's progress and to develop clinic benchmarks to compare to regional and national/international benchmarks for improvement of care (E). Outcome of careThe Diabetes Care Team should monitor outcomes for their patient population in order to identify areas of structure and process of care that could improve metabolic and other health outcomes (E).Comparing regional and national/international benchmarks is useful for improving outcomes (E) (7).The ultimate goal is to provide care that results in normal growth and development, high quality of life (QoL), and lowest possible risk of acute and long-term complications.This is best accomplished by helping children and families become proficient in selfmanagement, remain motivated throughout childhood and adolescence and allow children to develop into independent, healthy adults (E).Cost of care and treatment cost to benefit outcomes data over the child's lifetime are critical to providing optimal care to children with diabetes.A high priority should be given for collecting and providing such information to governments and healthcare agencies.Governments and policy makers must be involved so that adequate resources are provided for high-quality diabetes care.Continuous support from the International Diabetes Federation and other responsible organizations is essential for uninterrupted care of children in developing countries.Advocacy efforts and community education can promote awareness and understanding of diabetes, improving the safety and well-being of children with diabetes [E].