Compared with the adult population, the number of children and young people with T2DM in England is small (1560 under age 19 as of 2019-20). Prevalence is anticipated to increase, especially given the increasing number of children and young people who are overweight or living with obesity between the ages of 4 and 114). No formal health economic analysis was performed during this update.
Specialist teams managing T2DM in children and young people will need to gain familiarity with the newly recommended glucose lowering agents and arrange appropriate support for people and their families to access continuous glucose monitoring devices. Given the significant proportion of children and young people with T2DM who are not under specialist care, GP practices may consider systematically identifying registered children and young people with known T2DM who are not under such care to offer a referral and support as appropriate.
Further information on the guidance
Diabetes (type 1 and type 2) in children and young people: diagnosis and management guideline is available at https://www.nice.org.uk/guidance/ng18. The evidence review for glucose lowering agents is available at https://www.nice.org.uk/guidance/ng18/evidence and the resource impact statement at https://www.nice.org.uk/guidance/ng18/resources/resource-impact-statement-glucoselowering-agents-for-type-2-diabetes-13060980397.
This guidance was developed by NICE’s Guideline Development Team B in accordance with NICE guideline development methods (www.nice.org.uk/media/default/about/what-we-do/our-programmes/developing-nice-guidelines-the-manual.pdf). A guideline committee (GC) was established by NICE’s Guideline Development Team B, which incorporated healthcare and allied healthcare professionals (three consultant paediatricians with an interest in diabetes, two paediatric diabetes nurse specialists, two pharmacists, two GPs, one consultant diabetologist) and two lay members.
The guideline is available at https://www.nice.org.uk/guidance/ng18.
The GC identified relevant review questions and collected and appraised clinical and cost effectiveness evidence. Quality ratings of the evidence were based on GRADE methodology (www.gradeworkinggroup.org). These relate to the quality of the available evidence for assessed outcomes or themes rather than the quality of the study. The GC agreed recommendations for clinical practice based on the available evidence or, when evidence was not found, based on their experience and opinion using informal consensus methods.
The scope and the draft of the guideline went through a rigorous reviewing process, and stakeholder organisations were invited to comment on the draft of the guideline, the evidence review, and the equality and health inequalities impact assessment; the GC took all comments into consideration when producing the final version of the guideline.
NICE will conduct regular reviews after publication of the guidance, to determine whether the evidence base has progressed significantly enough to alter the current guideline recommendations and require an update.
How people with T2DM were involved in the creation of this article
Committee members involved in this guideline update included lay members who contributed to the formulation of the recommendations summarised here.