Patient discussions
Children and young people with type 2 diabetes mellitus (T2DM) and their families or carers should be offered a continuing programme of education from diagnosis. This should include the importance of managing glucose levels, including achieving and maintaining glucose and haemoglobin A1c (HbA1c) targets.[102] Patients should be informed that an HbA1c target level of 6.5% (48 mmol/mol) or lower will minimise their risk of long-term complications; however, HbA1c targets should be individualised for each patient, taking into account factors such as their daily activities, individual life goals, complications, and comorbidities.[1][102]
Advice should be given on how and when to take capillary blood glucose measurements (self-monitoring). Those patients who are offered continuous glucose monitoring should be provided with information about how to use their device.[102] Insulin-treated patients need to monitor blood glucose more frequently (before meals and before bedtime) than patients on oral drugs, and should be educated on the need to adjust insulin dosing according to meal composition.[1] They should also be educated about insulin delivery (including rotating injection sites within the same body region).[102] Those on oral drugs, such as metformin, should be advised about the benefits and possible adverse effects of these drugs.[102]
Patients and their carers should be given advice about how diet, physical activity, and intercurrent illness affect blood glucose levels.[102] Those on insulin need to be taught how to promptly identify the signs and symptoms of hypoglycaemia (i.e., shakiness, irritability, hunger, sweating, tachycardia, mood changes, confusion, dizziness). See Diabetic hypoglycaemia.
Patients and carers need to receive advice regarding optimum nutrition and exercise counselling from a registered dietician.[1][102] They should be advised that following a healthy diet, increasing physical activity, and reducing body weight can reduce the symptoms of T2DM, reduce cardiovascular risk, promote weight loss, and potentially lead to T2DM remission.[102] All older children and adolescents should be advised not to smoke; note that this includes not using electronic cigarettes or vaping.[1] Smoking cessation counselling should be included as a routine component of diabetes care. Patients should also be screened for substance and alcohol use at diagnosis and regularly thereafter.[1] As alcohol use has implications for glycaemic management and safety in young people with diabetes, patients should be educated about the risks and advised to reduce alcohol use if appropriate. All patients should be advised not to use cannabis recreationally in any form.[1]
Patients and carers also need to be educated on the monitoring for, and treatment of, other common complications (i.e., hypertension, dyslipidaemia, increased urinary albumin excretion). They should be advised to have regular dental examinations and eye checks.[102]
Transition to adult health care services is a critical period for young people with diabetes, and often comes at a time when they are becoming increasingly responsible for their own care. This is typically a period associated with reduced glycaemic stability, and may be associated with worsening diabetes outcomes.[1] It is therefore important that interprofessional adult and paediatric diabetes teams begin to prepare young people for transition to adult health care in early adolescence, including offering support and resources for transitioning young adults and their families.[1] Paediatric diabetes consultants should partner with youth with diabetes and their carers to engage in shared decision-making regarding the timing of transfer to an adult diabetes consultant; there is no age-specific cut-off for transfer.[1]
The Endocrine Society, in collaboration with the American Diabetes Association and other organisations, has developed transition tools for clinicians and for adolescents and their families. Endocrine Society: Transitions of care: managing pediatric to adult transitions of care Opens in new window
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