1. Childhood diabetes St Vincent Declaration Report from the 10th Anniversary St Vincent Declaration meeting

2. Childhood diabetes St Vincent Declaration Main aims of managing children with diabetes To ensure that children achieve: normal growth and development normal schooling and subsequent career goals optimal quality of life age-appropriate diabetes knowledge and self-care management

3. Childhood diabetes St Vincent Declaration Main aim of managing children with diabetes To ensure that clinics get: access to a quality focused computer programmes for easy data handling and surveillance

4. Childhood diabetes St Vincent Declaration Targets for glycaemic control Within 5 years: 50% of children should have HbA 1c values below 8% 85% of children should have HbA 1c values below 9% no children should have HbA 1c values above 10% severe hypoglycaemic events (loss of consciousness/ seizures) should be less than 20 per 100 patient years

5. Childhood diabetes St Vincent Declaration Targets for glycaemic control Re-admittance to hospital for recurrent episodes of ketoacidosis should be minimised All children with persistent microalbuminuria and/or elevated arterial blood pressure should receive relevant management

6. Childhood diabetes St Vincent Declaration Targets for clinic reviews Over 90% of all referred patients should attend the appointed clinic review visits Over 90% should have screening programme for complications at the age of 9,12,15 and 18 years at least and yearly examinations if the metabolic control is unsatisfactory or abnormalities are found Any children with a HbA 1c above 10% should achieve a 1% reduction of this value within a year

7. Childhood diabetes St Vincent Declaration To reach the targets It is recommended that the following should be available : multidisciplinary paediatric team, specially trained in diabetes, paediatrics and adolescent medicine: paediatrician, nurse educator, dietitian, psychologist with easy access to podiatrist, social worker and hospital teacher regular meetings of the diabetes team with the aim of establishing a quality circle to develop common goals and philosophy of diabetes treatment 24 hour hotline dedicated telephone service increased postgraduate education and training opportunities for the team

8. Childhood diabetes St Vincent Declaration Structured education programmes Preparation of age-appropriate education programmes, adjusted according to needs of the child and the level of maturity and family support Preparation of information sheets and guidelines for parents and children about how to cope with diabetes Organisation of peer-related activities outside the clinic setting (like camps, support groups, etc.) to enhance the educational programmes within the clinic should be encouraged Audits of the knowledge of diabetes and the theory of diabetes treatment among children and re-education as required

9. Childhood diabetes St Vincent Declaration Transfer to the adult clinic Early or late transfer (14/18 years?) Combined clinic (paediatric and adult team) Transfer clinic for young adults Optimal time for transfer is at 18 years in connection with end of puberty, transition from school to college or work, driving licence

10. Childhood diabetes St Vincent Declaration Transfer to the adult clinic The paediatric and adult teams should have a common philosophy and treatment guidelines should be the same None-attending patients should be reinforced to attend by their paediatric department