Even today, almost a century after the discovery of insulin, the most common cause of death in a child with diabetes from a global perspective is lack of access to insulin. Many children die before their diabetes is diagnosed. It is therefore of utmost importance that all forces unite to ensure that no child should die from diabetes. A promising initiative has been taken by IDF/Life for a Child in collaboration with ISPAD and other organisations (Access to Essential Diabetes Medicines for Children in the Developing World and Changing Diabetes in Children). Several major companies that produce insulin and other diabetes supplies have pledged their support, and the numbers of children provided with insulin will according to plan increase to approximately 30,000 by 2015. ISPAD has pledged structural support and assistance in the training of paediatricians and healthcare professionals in childhood and adolescent diabetes through its membership network.
In 1993, members of International Society for Pediatric and Adolescent Diabetes (ISPAD) formulated the Declaration of Kos, proclaiming their commitment to “promote optimal health, social welfare and quality of life for all children with diabetes around the world by the year 2000.” Although all the aims and ideals of the Declaration of Kos have not been reached by 2000, we feel that slowly, by small steps, the worldwide care of children with diabetes is improving.
ISPAD published its first set of guidelines in 1995 and its second in 2000. Since then, the acceptance of intensive therapy, also for very young children, has increased around the world. Insulin pump usage has risen in all age groups in countries where this treatment modality can be afforded. Intensive therapy requires better and more comprehensive education for it to be successful. The ISPAD Consensus Guidelines 2000 edition has been translated into 11 languages, indicating the need for a truly international document. The 3rd edition of ISPAD´s Consensus Guidelines, now called “Clinical Practice Consensus Guidelines” was released in 2009.
The current guideline has been developed by ISPAD and the International Diabetes Federation. While there is extensive evidence on the optimal management of type 1 diabetes, unfortunately such care is not reaching many people who could benefit.
Guidelines are one part of a process which seeks to address those problems. In 2005 the first IDF Global Guideline for Type 2 Diabetes was developed. This presented a unique challenge as we tried to develop a guideline that is sensitive to resource and cost-effectiveness issues. Many national guidelines address one group of people with diabetes in the context of one healthcare system, with one level of national and healthcare resources. This is not true in the global context where, although every healthcare system seems to be short of resources, the funding and expertise available for healthcare vary widely between countries and even between localities.
Despite the challenges, we feel that we found an approach which is at least partially successful in addressing this issue which we termed ‘Levels of care’.
We hope the guidelines will be widely consulted and will be used to:
- improve awareness among governments, state health care providers and the general public of the serious long-term implications of poorly managed diabetes and of the essential resources needed for optimal care.
- assist individual care givers in managing children and adolescents with diabetes in a prompt, safe, consistent, equitable, standardised manner in accordance with the current views of experts in the field.
IDF/ISPAD Pocketbook for the Management of Diabetes in Childhood and Adolescence in Under-Resourced Settings
The IDF Life for a Child Programme and ISPAD decided it was appropriate to develop a shortened version of these guidelines aimed to be of practical use in emergency situations and in clinics that are developing expertise in managing diabetes in children. The Pocketbook provides basic background on diabetes in children and clear advice for initial management of diabetic ketoacidosis, initiation of maintenance insulin therapy, complications screening, and other key components of care.