1. Zosia L Beckles, information scientist1,
  2. Julie A Edge, consultant in paediatric diabetes2,
  3. Moira A Mugglestone, director1,
  4. M Stephen Murphy, clinical director for children’s health1,
  5. Jerry K H Wales, director of endocrinology and professor3
  6. On behalf of the Guideline Development Group
  1. 1National Collaborating Centre for Women’s and Children’s Health, Royal College of Obstetricians and Gynaecologists, London NW1 4RG, UK
  2. 2Oxford Children’s Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
  3. 3Lady Cilento Children’s Hospital and University of Queensland, Brisbane, QLD 4101, Australia
  1. Correspondence to: M A Mugglestone mmugglestone{at}rcog.org.uk

What you need to know

  • Immediately refer any child or young person with suspected type 1 diabetes characterised by random plasma glucose >11 mmol/L, polyuria, polydipsia, weight loss, excessive tiredness, or DKA to a multidisciplinary paediatric diabetes team

  • Agree an individualised lowest achievable HbA1c target, taking into account daily activities, life goals, complications, comorbidities, and, in type 1 diabetes, the risk of hypoglycaemia

  • For type 1 diabetes, offer multiple daily injection basal-bolus insulin regimens with level 3 carbohydrate counting education from diagnosis, provide blood ketone testing strips and a meter, and advise testing for ketonaemia if the child is ill or has hyperglycaemia

  • For type 2 diabetes, offer standard release metformin from diagnosis

Type 1 diabetes affects more than 25 000 children and young people in the United Kingdom and type 2 affects about 500, with both types becoming more common.1 Life threatening complications, including diabetic ketoacidosis (DKA), can occur with both type 1 and type 2 diabetes. Prompt recognition and effective management of diabetes and associated complications are essential. This article summarises new recommendations from the National Institute for Health and Care Excellence (NICE), which for the first time cover type 2 diabetes and the recognition and management of DKA in children and young people.2

What’s new in this guidance?

  • A reduced ideal HbA1c target

  • Multiple daily injection basal-bolus insulin regimens from diagnosis for type 1 diabetes

  • Management of type 2 diabetes

  • Recognition and management of DKA


NICE recommendations are based on systematic reviews of best available evidence and explicit consideration of cost effectiveness. When minimal evidence is available, recommendations are based on the Guideline Development Group’s experience and opinion of what constitutes good practice. Evidence levels for the recommendations are given in italic in square brackets.

General principles

Type 1 and type 2 diabetes: recognition, diagnosis, and referral

  • Be aware that characteristics of type 1 diabetes in children and young people include hyperglycaemia (random plasma glucose >11 …

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