Earlier this month the National Institute for Health and Care Excellence (NICE) released a set of new quality standards containing details that should become a major influence in addressing the current lack of care available to children and young people suffering from diabetes and a related eating disorder.
Their quality standards publication for 14th July provides recommendations regarding the diagnosis and management of type one and two diabetes for those under the age of 18. It also contains some important guidelines in relation to psychological and emotional health which DWED hopes to have fed into. We are so pleased to finally see this being implemented by NICE and duly hope it will bring about change that is long overdue.
Conclusions in the report were reached by local data collection and the 2013–14 National Paediatric Diabetes Audit. Results unsurprisingly concluded that individuals with diabetes were more at risk of mental health problems including depression, anxiety and eating disorders. This can be due to a number of factors such as alienation from peers, ignorance from the public and media, bullying and the fear of being different.
Eating disorder behaviours can often begin at an early age and although diabulimia may develop later, anorexic or bulimic tendencies are shown to start alarmingly early. This may often lead to the process of insulin omission in a type one diabetic. There is undoubtedly a link between body image concerns and the introduction of insulin in adolescents, not to mention the focus on food that becomes necessary to ensure steady glucose control.
The quality standard suggests that best practice would mean children and young people with type 1 or type 2 diabetes would have access to mental health specialists that understand the types of problems people with diabetes may have. It specifies that a mental health professional should be one of the main members of the diabetes team.
Of course early intervention for all eating disorder cases is hugely significant as the sooner that an individual receives help the more likely they are to recover. Physical complications are also less probable, and with diabetes this can be crucial in preserving long-term quality of life. Devastating consequences of ED-DMT1 and diabulimia can be nerve damage, sight loss, kidney impairment as well as difficulties with nutritional absorption and digestion.
So what exactly does all this mean? In simple terms clinicians will have support in recognising and addressing psychological difficulties in the patients they see. Young people can speak up for themselves with backing of the NICE initiatives, and family and carers will also have the resources available to seek support on their children’s behalf if they notice any worrying signs. This will hopefully lead to the appropriate help being introduced sooner and give ED-DMT1 and/or diiabulimia less chance of digging in its ugly claws. It should mean fewer ambulances called, fewer hospitalisations and fewer deaths.
DWED can facilitate on your behalf if you feel you need help with the advocacy process. We are providing this by way of a specialised fact-sheet outlining the NICE recommendations which can be used in communication with your own or your child’s diabetes clinic, GP or nurse. This will contain all relevant information concerning what clinicians should be providing in the way of treatment of mental difficulties. It will outline what the NICE quality standards suggests and encourage health care professionals to address psychological concerns that they may be overlooking. It will also include relevant quotes from the Quality Standards publication to support any eating disorder specific recommendations. Additionally the document includes a detailed breakdown of the updated NICE Guidelines and Quality Standards for adults. By signing up for membership you will also be given access to monthly premium content.
Nice Quality Standards regarding long term conditions and another regarding co-morbidities and complex needs are also planned for the near future, details of which can be found in a downloadable spreadsheet which is linked via the NICE website's Quality Standards Topic Library. DWED hopes that all of these reports will include advice pertinent to the awareness, understanding and tailored treatment required for cases of ED-DMT1 and/or diabulimia.
By Claire Kearns.