← NZ Child & Youth Clinical Network

Clinical Network for Children and Young People with Diabetes

As kaitiaki (caregivers/guardians) of diabetes related services, it is a collective responsibility to establish an environment that facilitates a pathway for people with diabetes to navigate te ao mate huka - the world of diabetes. *

*Te Kaiwhakahaere Māori te Roopu mate huka Debbie Rawiri - Te Whatu Ora Waitaha (Canterbury)

Approximately 2,000 tamariki and their whānau in Aotearoa live with the ongoing burden of diabetes care. Worryingly, the rates of type 2 diabetes are rising among taitamariki, which is a significant concern. Disparities in diabetes outcomes are heavily influenced by ethnicity and socioeconomic status, with Māori, Pasifika, and those in deprived communities at the highest risk of developing both short- and long-term complications. Regional variations in workforce availability, outcomes, and access to gold-standard therapies further exacerbate these disparities.

Network priorities

People: Nga Tāngata: We are focused on developing national tools and mechanisms to equip and support whānau in actively participating in their healthcare. By promoting health workforce development, we aim to empower professionals to deliver culturally safe, evidence-based care.

Partnerships and Connectedness: Our role as the expert advisory group for taitamariki diabetes in Aotearoa is strengthened through active partnerships and leadership across the health sector.

Improving Practice: Our efforts to enhance equity in healthcare for tamariki and rangatahi focus on quality improvement initiatives. We prioritise communities disproportionately affected by diabetes, including Māori, Pasifika, and disabled populations.

Sustainability: To ensure the long-term success of the clinical network, we are embedding sustainable practices and actively recruiting new members. Our recruitment efforts are focused on ensuring that the voices of Māori, Pasifika, and whānau are well-represented on the Reference Group, enabling us to maintain diverse perspectives in our work.

 

 

Clinical Resources and Guidelines

As kaitiaki (caregivers/guardians) of diabetes related services, it is a collective responsibility to establish an environment that facilitates a pathway for people with diabetes to navigate te ao mate huka - the world of diabetes1

Ehara taaku toa i te toa takitahi, engari he toa takitini
My strength is not as an individual but as a collective.

Transition is “a planned, purposeful movement of the adolescent or young adult with a chronic disease from a child (and family) centred to an adult centred health care system.” (ISPAD, 2018)

The transition from a paediatric to an adult orientated service should be an organised process of preparation and adaption, where care is delivered from a healthy youth development approach. The appropriate age for transfer from paediatric to adult care may vary due to the maturity of the young person/rangatahi, the availability of the appropriate service for the rangatahi and local service structures.

Whānau and the wider support network are considered the principal source of strength, support, security and identity hence their involvement is an important consideration in the planning and interaction with rangatahi.

You can download a pdf of the Diabetes Transition Consensus Statement here.

Key principles

Preparation

The transition process should occur with adequate timing and appropriate supports. Parents and whānau are vital to the process.

  • Begin at least 12 months before transferring

  • Parents/whānau role is emphasised through the whole process and their concerns discussed

  • Rangatahi and whānau need to be aware of differences between paediatric and young adult/adult services and what to expect

  • Rangatahi are given the opportunity for privacy and confidentiality unless there are safety concerns

  • Identification of knowledge issues and diabetes distress so can be addressed as appropriate

  • Identification of key stakeholders in the life of the rangatahi

Useful Documents

Co-ordination

The goal of transition to encourage rangatahi to remain engaged in diabetes care and with diabetes care providers. This is achieved through clear communication between paediatric and young adult services, rangatahi and whānau.

  • Written information made available about new service and team

  • Written documentation summarising biomedical and psychosocial assessment and cultural engagement.

  • Psychosocial Assessment including HEEADSSS - mnemonic for Home, Education and Employment, (eating and exercise), Activities and peers, Drugs, Sexuality, Suicide and depression, Safety, Spirituality

  • Cultural Engagement including marae, connections to iwi, hapu and whānau

  • Confirmation of receipt of information

  • Caregivers/whānau are involved and aware

  • Primary care are included in all correspondence

  • Youth health information is provided by both services

Useful Documents
Fact Sheets

Success

Successful transition is determined by rangatahi being engaged with a service by attending appointments regularly or alternatively transferred to a health service that engages with them.

  • Systematic review of accessibility to service as measured by “Did not attend rates”

  • Clinicians are actively involved and interested in youth

  • Rangatahi with diabetes continue to be seen by a specialist diabetes team every 3 months or more if required as recommended by ISPAD (2022).

  • Member of the multidisciplinary team is designated the Transition Co-ordinator to support the transition process.

Useful Documents

1Te Kaiwhakahaere Māori te Roopu mate huka Debbie Rawiri - Te Whatu Ora Waitaha Canterbury

The Clinical Network, in collaboration with Diabetes New Zealand, has developed national Diabetes Camp Guidelines for non-school-based camps.

One of the primary outcomes of this work is the development of a collection of diabetes action and management plans. This collection of documents is intended to provide a formal guide for the consistent care and management of children and young people with diabetes in schools and early childcare organisations.

New camp guidelines have been developed: see Management plan for school camp and Whānau and school checklists .

In addition the Clinical Diabetes Network have created NZQA medical certificate templates for both type 1 diabetes mellitus and type 2 diabetes mellitus treated with insulin, to be used to support 'special assessment condition' applications for students with diabetes. 

Diabetes action and management plans

The diabetes action and management plans have been developed by the National Clinical Diabetes Network for use in New Zealand. These diabetes action and management plans are provided for use in secure PDF format only. The expectation is that they are personalised (filling in name and other details, ticking relevant boxes where indicated) by the family and young person in consultation with the diabetes treating team and the school. The plans are reviewed and updated regularly to reflect any changes in clinical best practice diabetes care.

Type 1 diabetes

Download or view a pdf of the following diabetes action and management plans for kindergarten or early childhood settings:

Download or view a pdf of the following diabetes action and management plans for primary and secondary schools:

Questions or comments about the plans are welcome and should be directed to diabetescn@paediatrics.org.nz 

Type 2 diabetes

Download or view a pdf of the following diabetes action and management plans for primary and secondary schools:

Diabetes and School Camps

It is important that any child with diabetes can fully participate in the school curriculum. This involves school camps and excursions, regardless of whether it is a day event or overnight. For these to be successful, preparation is paramount. The following guideline includes checklists of things that both family and whānau need to consider as well as the school. See the Management plan for school camp and the Whānau and school checklists here.

Exams and Diabetes

Download or view a pdf of the information sheet for young people with diabetes and exams.

For medical certificate templates to be used to support   'special assessment condition' applications for students with diabetes, choose Type 1 Diabetes, or Type 2 Diabetes

The New Zealand Context

Over the last few years there has been a rapid uptake and interest in glucose monitoring systems in Aotearoa. Following on from strong advocacy, Pharmac have made the decision to fund a range of continuous glucose monitors and insulin pumps from October 1st 2024 for all people with type 1 diabetes. Many clinicians and whānau have questions about these devices. The Paediatric Society of New Zealand Clinical Network for Children and Young People’s Diabetes Services recognise this need and have put together the following two resources to provide comparison information of the systems that will be funded and available in New Zealand from October 1st.

Continuous Glucose Monitoring Systems

Continuous glucose monitors (CGM) are devices that monitor glucose levels in people with diabetes. The devices are another tool for the management of diabetes. They can be helpful in minimising the number of finger-pricks required. They can also show patterns and trends in glucose levels. Certain systems will be available by Special Authority and prescription from October 1st 2024.

Side by side comparisons of Glucose Monitoring Systems

This comparison table of the features of the most current systems available (or going to be released) in New Zealand is designed to help you find the technology that best meets individual needs and preferences.

View or download the comparison table shown below via this link

Insulin Pumps

An insulin pump (continuous subcutaneous insulin infusion) is a small device that constantly delivers rapid acting insulin. Insulin pumps reduce the need for multiple injections a day. When combined with a CGM this creates automated insulin delivery system. Initiation of insulin pump therapy is provided through local diabetes team who have specialised training and education.

Side by side comparisons of Funded Insulin Pumps

This comparison table is of the features of the two pumps that will be funded by Pharmac in New Zealand from October 1st 2024.

View or download the comparison information shown below via this link

 

There are many myths and facts associated with Continuous Glucose Monitors and Insulin Pumps. Please see the Myths and Facts information sheet here for helpful information for your mahi.

Please note this information is constantly changing and will be updated as new details come in.

The Clinical Network, in collaboration with Diabetes New Zealand, have undertaken two projects about camps for children with diabetes in New Zealand. The first is the Diabetes Camp Guidelines and the second is a national survey about school camps and excursions for children with diabetes.

Diabetes Camping Guidelines

These guidelines have been designed to ensure that the health and safety of young people with diabetes is maintained at all times during camp.

It is recommended that all Diabetes New Zealand Groups and other New Zealand groups organising camps for young people or families with diabetes follow these guidelines, wherever possible and appropriate.

The information contained within these guidelines is provided for reference purposes and is not intended to be a complete manual or handbook, nor is it intended to provide requisite forms, policies or procedures for diabetes camps. Every camp should develop its own materials that address the safe and effective provision of services to children with diabetes in its own unique camp setting - these services must meet the regulations of local and national government/accrediting bodies. The information provided here is intended to guide those involved through the process.

Click on the image to the right to download a full copy of the guideline.

The Clinical Network endorses the Australasian Paediatric Endocrine Group guidelines for the Screening, assessment and management of Type 2 Diabetes Mellitus in children and adolescents (https://doi.org/10.5694/mja2.50666)

 

Whānau Resources

Network News and Updates