Abstract
Juvenile type 1 diabetes is a chronic form of insulin-dependent diabetes mellitus that manifests in children. The condition is typified by the inability of cells to absorb and utilize glucose due to the destruction of the pancreatic islets of Langerhans that secrete insulin. Type 1 diabetes causes drastic changes in the lives of children who are forced to adapt to tedious medical regimens to enable them to lead healthy lives.
The provision of education to children and adolescents living with type 1 diabetes and their families has been shown to be the most effective method of intervention. This form of intervention improves the biophysical and psychological outcomes in juvenile type 1 diabetes by equipping the patients to manage their condition.
Northwest England is characterized by deprivation in comparison to other parts of England. Various studies link deprivation to increased prevalence of chronic conditions such as diabetes. However, the prevalence of juvenile type 1 diabetes in the region is lower than other affluent regions due to the efficacy of educational programs in the management of type 1 diabetes.
Overview of Diabetes
Diabetes mellitus is a persistent, progressive health condition where the amount of glucose in the blood surpasses the required normal ranges. The raised amounts of glucose in the blood are attributed to a malfunction in the functioning of the pancreas, which fails to secrete adequate insulin.
Insulin is a peptide hormone that is responsible for normalising the quantity of glucose in the bloodstream. Alternatively, diabetes mellitus can come about when the body is incapable of utilising insulin. Consequently, two forms of diabetes exist namely type 1 and type 2. Type 1 diabetes, which is also called insulin-dependent diabetes, arises when the pancreas fails to generate insulin.
The condition frequently arises in patients before they reach age 40 and is managed by the administration of insulin injections as well as the intake of regulated diets. Type 2 diabetes, in contrast, develops because of the failure of the body to utilise insulin. This condition is also known as insulin-independent diabetes mellitus.
Juvenile Type 1 Diabetes
Juvenile type 1 diabetes mellitus is the form of insulin-dependent diabetes mellitus that occurs in children and adolescents. This form of diabetes is classified as the third frequently occurring chronic illness in young people.
Causes
The precise cause of juvenile type 1 diabetes is unknown. However, it has been established that the immune system plays a role in the development of the condition and that genetics influence the development of the disease.
Symptoms
The indications of insulin-dependent diabetes in children comprise increased need for water, regular urges to pass urine and extreme food cravings. The accumulation of sugar in the bloodstream draws water from the tissues hence causing dehydration. As more water is taken, more of it is excreted by urination.
Extreme hunger occurs due to the inability of glucose to be taken up by the cells. The starved cells, tissues and organs are depleted of energy hence causing hunger. A diabetic child experiences weight loss, which is among the first noticeable signs. Exhaustion and weariness also arise due to the lack of glucose to generate energy in the cells.
There may be irritability and sudden mood changes as well as blurred vision. In girls with type 1 diabetes, there are frequent incidences of yeast illnesses. Other symptoms of the disease include decreased wound healing, low blood pressure and temperature, a fast heart rate, aches in the abdomen, queasiness, and vomiting.
Risk Factors
There are two key risk factors for the development of juvenile-onset diabetes in children. The first risk factor is genetics where the presence of certain genes increases the likelihood of developing the condition. The type of gene associated with the development of type 1 diabetes is a genetic marker that is situated on chromosome 6.
This marker is a human leukocyte antigen (HLA) complex whose presence increases the odds of developing the condition. The second risk factor is family history where individuals with parents or siblings with type 1 diabetes are more prone to developing the condition than children without a family history of diabetes. This factor can be attributed to the inheritance of the HLA complex marker.
Other factors such as viral infections, ethnicity, diet, and geography have also been associated with elevated risks of having juvenile type 1 diabetes. Attacks by viruses such as the Epstein-Barr virus, rubella and Coxsackie may stimulate the immune system to generate autoantigens that lead to the destruction of the islet cells (Majeed & Hassan, 2011).
Certain races are more predisposed to type 1 diabetes than others. For example, Whites are more susceptible to type 1 diabetes than Blacks and Hispanics. Conversely, the Chinese and South Americans have lower probabilities of having the condition.
The diet provided to children in the early stages of life plays a role in the development of type 1 diabetes. Previously, it was thought that an intake of vitamin D lowered the chances of having the condition (Hyppönen, Läärä, Reunanen, Järvelin, &Virtanen, 2001).
However, it has been established that feeding infants with cow’s milk, which is a rich source of vitamin D, increases their chances of developing diabetes (Casu, Pascutto, Bernardinelli, The Sardinian IDDM Epidemiology Study Group, & Songini, 2004). In addition, the intake of nitrate-rich water increases the chances of developing type 1 diabetes.
Childhood weight and height also play a role in the development of juvenile type 1 diabetes. A study by Hyppönen et al. (2000) established that obesity and rapid linear growth correlated with the incidences of type 1 diabetes. Risky lifestyles such as smoking, drinking and the use of drugs in early teens may also increase the risk of developing the disease in otherwise healthy teenagers.
Diagnosis
The identification of juvenile diabetes among the young people is often direct and does not involve the performance of unusual tests. A large fraction of young adults with insulin-dependent diabetes has symptoms such as frequent urges to pass urine, intermittent need for liquids as well frequent cravings for food, which are often there for a number of weeks.
Their urine and blood may also contain ketone bodies and elevated glucose levels. Additionally, some children present with glycosuria alone without other accompanying indicators such as ketonuria due to a low kidney glucose upper limit. Therefore, the presence of elevated blood sugar levels must be established to identify diabetes. In the same way, the discovery of high blood glucose levels without the presence of the other archetypal symptoms does not imply that the patient is diabetic (Silverstein et al., 2005). However, such a patient needs to be referred to a paediatric endocrinologist for further examination.
The guidelines for the diagnosis of diabetes include the presence of classic diabetic indicators as well as a casual plasma glucose level that equals to or exceeds 200 milligrams per decilitre (American Diabetes Association, n.d.). Casual glucose implies that the test is taken at any time of the day without considering the intake of the last meal.
In the case of fasting (abstaining from calories for at least eight hours), the discovery of fasting plasma glucose levels that are equal to or more than 126 mg/dl indicate probabilities of diabetes. Conversely, an oral glucose tolerance test that provides 2-h plasma glucose levels of 200mg/dl or more indicates that the patient may be diabetic. These tests, however, need to be done again to corroborate the finding.
Management
Children have traits and requirements that dictate standards of care that differ from adults. Therefore, the provision of care in diabetic children ought to keep in mind the disparities between kids and adults. For example, the administration of insulin should not be based merely on the various body sizes since low blood sugar responses vary greatly between children and adults. In addition, puberty plays a significant role in the chances of development of diabetic complications.
Consequently, the provision of guidance on the management of diabetes ought to be tailored to the age of the patient and needs to include the patient’s parent or caregiver. Furthermore, school-going children are unable to care for themselves independently while adolescents require constant monitoring and guidance.
For these reasons, education on caring for diabetic children and adolescents needs to include the entire family. The education ought to call attention to age and developmentally suitable self-care, which should gradually empower the children to take care of themselves as they progress from childhood to adolescence and into adulthood.
Following a diagnosis of diabetes, a child needs to be examined by a team of diabetes experts that comprises a paediatric endocrinologist, a dietician, a mental health professional and a nurse practitioner. This team is vital in coming up with a current, paediatric-specific edification and encouragement (Silverstein et al., 2005).
About 30% of all children with newly-diagnosed type 1 diabetes usually suffer from diabetic ketoacidosis (Diabetes UK, 2013). Some of them may be seriously ill and may require to be hospitalized during the administration of initial diabetic care. Children without life-threatening symptoms may be released and cared for in the comfort of their homes (NHS Diabetes, 2010).
Overall, the management of type 1 diabetes involves the integration of insulin therapy into the individual patterns of diet and physical activity (American Diabetes Association, 2007).
Northwest England
North West England comprises one of the most socially deprived regions of England (Harwood, Mytton, & Watkins, 2004). The region comprises diverse ethnic groups including Asians and Blacks. Whites make up 94.4% of the population while Indians account for 1.1% of the total population.
The Pakistani, Bangladeshi and other Asians account for 1.7%, 0.4% and 0.2% of the population respectively. Black Caribbeans, Black Africans other Blacks make up 0.3%, 0.2% and 0.1% of the northwest population. The Chinese account for 0.4% of the population while other minority unspecified groups comprise 1.1% of the population. Overall, the minority groups make 5.6% of the entire population.
It is estimated that 2.2% of people in North West England are living with type 1 diabetes. A large proportion of people in the region comprises skilled, partly skilled and unskilled manual workers while a tiny proportion works in professional, managerial and technical positions. Several studies indicate that there is a strong association between social deprivation and the prevalence of diabetes (Lopez, Mathers, Ezzati, Jamison, & Murray, 2006).
The risk of diabetes is approximately one and a half times higher in underprivileged populations than in least deprived populations. Therefore, it is expected that the incidence of chronic illnesses such as diabetes is high in such regions.
The Needs of the Population
There is inadequate knowledge on the management of diabetes among the people of North West England, which can be attributed to the social class of a majority of the populace. There is substantial proof from other conditions that access to services is influenced by material comfort and poverty. It has been established that socioeconomic attributes affect access to care within various populations and health services.
In the UK, for example, studies regarding diabetic populations reveal that morbidity is associated with socioeconomic attributes and that deprivation leads to inferior diabetes management and incorrect insulin usage. The lack of adequate knowledge regarding the condition leads to poor management of the condition and leads to the underutilisation of preventive services (Harwood, Mytton, & Watkins, 2004). In addition, the Pakistani women living in North West England have inferior glycaemic control practices and know-how of self-monitoring due to their poor educational backgrounds.
The population of North West England does not have adequate care for diabetic patients. Therefore, the National Service Framework for Diabetes has established a few policies to guide the delivery of proper health care to all diabetic patients. These strategies include the identification of people with diabetes and empowering them to take good care of themselves.
It also involves the provision of clinical care of diabetic patients and urging the patients to lead healthy lifestyles (Harwood, Mytton, & Watkins, 2004). All diabetic children are set to get assistance and attention to improve the regulation of their blood glucose levels. The support is also aimed at improving their bodily, mental, academic, didactic, and social development. Consequently, there is likely to be a smooth changeover from childhood to adult care services for each patient at suitable ages.
Incidences of Juvenile Type 1 Diabetes
The total number of children under seventeen years living with type 1 diabetes in North West England by 2009 was 2,630 children out of the 1,498,716 of children under the age of 17 in the region (Royal College of Pediatrics and Child Health, 2009). The incidence translated to a prevalence rate of 175.5 out of every 100,000 children aged seventeen and below. The prevalence of juvenile type 1 diabetes in the northwest was the seventh out of the ten regions of England.
The prevalence was slightly lower than the expected incidence of 2,792.7 using the overall prevalence of type 1 diabetes in the entire country. The highest prevalence rates were recorded in North East Coast and South East England.
Variations of the Incidence of Type 1 Diabetes across Different Groups
Out of the 2630 children with type 1 diabetes, 97 fell in the age group of 0 to 4 years while 527 fell between the ages of 5 and 9 years. 1153 of the children were between the ages of 10 and 14.
Conversely, 302, 338 and 213 children were aged 15, 16 and 17 respectively. The age-related prevalence (per 100,000 population) of the disease in the region was 24.1 among children between the ages of 0 and 4 years; 218.7 among those aged between 5 and 15 years and 290.1 among teenagers between 16 and 17 years (Royal College of Paediatrics and Child Health, 2009). The numbers of school-going children between the ages of 5 and 15 with type 1 diabetes in North West England were 2,042 and 575 for those aged between 16 and 17.
The prevalence of type 1 diabetes in North West England was higher among the racial minority inhabitants particularly the Bangladeshi.
Risk Factors
Ethnicity is one of the main risk factors of type 1 diabetes in northwest England. It has been reported that a large number of people hospitalized for type 1 diabetes-related complications come from multicultural centres. Other factors that increase the chances of the condition include smoking and fatness. It is estimated that 15% of professionals in North West England are smokers while 42% of the manual labourers are smokers (Harwood, Mytton & Watkins, 2004).
Though children do not smoke, they are exposed to secondary smoke from their parents in their homes and other surroundings hence increasing their chances of developing diabetes. A large proportion of the children in northwest England is obese hence elevating the chances of having type 1 diabetes. Genetics and family history also increase the chances of developing type 1 diabetes in the region.
Access to Services
A large number of children living with type 1 diabetes receive specialized care from paediatricians who are well-versed with endocrinology and diabetes (Royal College of Paediatrics and Child Health, 2009). Most of these professionals are also members of diabetic organisations such as ACDC or BSPED (British Society for Paediatric Endocrinologists and Diabetologists). However, a small fraction of the children receives health care from general paediatricians or adult physicians as they approach adulthood.
Nearly all hospitals in the northwest have devoted specialist diabetes services to cater for the affected part of the population. The personnel involved include medics, nurses, the management, book-keeping staff, and allied health professionals such as dieticians (Harwood, Mytton, & Watkins, 2004).
In the UK, a number of groups have been developed to help the population cope with the incidences of type 1 diabetes. An example is the Dose Adjustment for Normal Eating (DAFNE) group, which was first established in Germany. The group provides an effective inpatient instructive program for type 1 diabetes patients.
The sessions cover 35 hours per week and are divided into seven daily sessions each lasting five hours. The initiation of DAFNE has seen the development of other teams that offer short learning programs for approximately 24 hours that extend over four to six weeks.
Intervention Strategy and the Reduction of Type 1 Diabetes Disease Burden and Inequalities
Children and young people living with diabetes ought to have access to the best medical care that gives them the power to handle their condition on a daily basis. This group of people ought to receive specialized care that goes farther than hospital settings to ensure that they can lead their daily lives in a manner that is clinically favourable and psychologically appropriate. However, the provision of health care can only be improved with the availability of accurate data regarding the number of diabetic children in North West England. Such information is vital in the designing and the provision of quality health care.
The most appropriate intervention strategy to lower the problem of juvenile type 1 diabetes among children and adolescents in North West England is the provision of diabetic children and their families with adequate education on the disease. The importance of education has been established in numerous studies involving children, adolescents as well as adults.
Evidence of the Effectiveness of Education in the Management of Type 1 Diabetes
It is reported that proper education of families of children with type 1 diabetes leads to a substantial decline in incidences of hospitalization of children with the condition. The delivery of intensive diabetes care and the establishment of close contact with the diabetes team have also been achieved through telephone communication. These measures have reduced instances of emergency hospital visits and the overall cost of treatment. The success of patient education in the management of adult type 1 diabetes has been extrapolated into the management of diabetes in children.
In a proposed randomized pragmatic clinical trial, George et al., (2007) intended to administer a course named Brief Intervention in Type 1 diabetes: Education for Self-efficacy (BITES) to 54 diabetic individuals who were enrolled for diabetic services in healthcare settings for 12 months. The researchers intended to compare their outcomes with those of the control group of 60 patients.
Thereafter, in the actual trial, George et al. (2008) enlisted the treatment group into educational sessions that extended for six weeks during which the patients were able to reflect and practice the knowledge gained. To ensure that the information was internalized, the patients were introduced to fictitious diabetic patients and were encouraged to devise ways of helping these conjured patients cope with diabetes.
The control group, on the other hand, continued with its normal diabetic clinics and other study appointments. Levels of haemoglobin A1c, as well as incidences of hypoglycaemia and hyperglycaemia, were recorded at the beginning of the trial and thereafter at three-month intervals. In addition, other features such as basal metabolic indices, blood pressure, lipid profile and the number of daily insulin injections were also recorded. The patients were made to complete a questionnaire to assess their knowledge, contentment with the program, and psychosocial wellbeing.
It was established that the brief intervention did not have a substantial impact on the levels of HbA1c and incidences of severe hyperglycaemia (George et al., 2008). However, the intervention led to an improvement in diabetes treatment contentment. In addition, the patients were empowered to handle their diabetic condition in a better way.
The outcomes of the study agreed with the findings of Couch et al. (2008), which established the efficacy of diabetes education in metabolic regulation, frequency of hospitalization, diabetes knowledge, psychosocial wellbeing, and the quality of life of children with type 1 diabetes and their families. It was established that HbA1c quantities revealed the effectiveness of a diabetes management strategy. Therefore, patient education in diabetes should aim at achieving the lowest rates of HbA1c without frequent episodes of hypoglycaemia (Couch et al., 2008).
Components of Education
A comprehensive education program should consider the individual and cultural needs of the patient. The program also needs to consider the patients’ siblings who may feel disregarded due to increased attention paid to the patient because of the new diagnosis (NHS Diabetes, 2010). Therefore, the educators ought to have combinations of various skills such as sensitivity, good communication skills, empathy, humour, and a comprehensive understanding of childhood diabetes.
The information and mode of delivery need to be suited to paediatric needs. In an idyllic situation, a group of approved specialists needs to provide the education in a manner that addresses family dynamics and issues facing the entire family. This group should include a doctor, a mental health expert, an advanced nurse practitioner and a nutrition expert. However, burdening the family with many details on the management of the disease may not be effective immediately after diagnosis because they may still be in shock or angered by the life-changing diagnosis (Silverstein et al., 2005).
Continued Education
Continued education ensures that the diabetic patients are well-equipped to manage their situation at all developmental stages. Families and their children need to receive regular education and support to ensure the children develop more elements of self-care as they grow (Daneman, 2006). The educational sessions can be flexible to allow diabetic adolescents to come along with their close friends for peer support. Adolescents with diabetes often experience bodily, emotional, mental strain because of the pressure of a complex medical routine (Davidson, Penney, Muller, & Grey, 2004).
These pressures often lead to nonconformity. During adolescence, there is diminished reliance on parents and increased dependency on friends for encouragement and behavioural standards. A study by Greco, Pendley, McDonell, and Reeves (2001) has established that peer support provides company and emotional support with respect to diabetes care.
Self-Management
Self-management is the foundation of effectual preventative care in diabetes. Educational interventions that impart self-management skills to children living with diabetes have been reported to be effective in the reduction of blood glucose levels. Consequently, incidences of complications associated with elevated blood glucose levels decrease. Additionally, such measures have been shown to be biophysically and psychologically effective (George et al., 2007).
Factors such as age, cognitive capabilities, emotive maturation, and the motor advancement of the patients influence their capacity to take part in self-management of diabetes. Parental presence is vital throughout to guarantee proper self-management and metabolic regulation. However, it is vital that certain self-management capabilities are present at various developmental stages (Silverstein et al., 2005). Guidelines to these capabilities are provided and attained during educational sessions.
Blood Glucose Monitoring and Glycaemic Control
The management of type 1 diabetes seeks to keep blood sugar levels within the acceptable ranges. HbA1c is the ultimate yardstick for evaluating the control of diabetes. It has been established that reduced levels of HbA1c correspond to a low incidence of microvascular complications (Couch et al., 2008).
During adolescence, the numerous changes that occur lead to insulin resistance hence necessitate higher doses of insulin. It has been reported that HbA1c levels in diabetic adolescents are one percent higher than in other diabetic patients (Australasian Paediatric Endocrine Group, 2005). Therefore, adolescents with type 1 diabetes face the risk of worsening of glycaemic control, hypoglycaemia, relentless diabetic ketoacidosis and hastened microvascular difficulties.
Young people with type 1 diabetes have to cultivate self-worth and self-reliance at a time when diabetes management is extremely taxing. Consequently, these education sessions help prepare adolescents for these eventualities and help them be psychologically prepared.
The Use of Insulin in the Management of Diabetes
The inception, peak and longevity of insulin activity depend on the nature of insulin and the location where the injection is administered. Individual responses to insulin may also affect the impact of the drug as different people react differently to drugs. Overall, the available forms of insulin include those that act rapidly, short-acting insulin, intermediate-acting insulin, and long-acting insulin. These various forms may be administered singly or in combinations.
There is no specific modus operandi of finding the insulin needs of a child. However, insulin doses are determined by the age, weight and state of puberty (Silverstein et al., 2005). Younger children require small doses while older ones need elevated insulin doses due to hormonal alterations at puberty. Advice on the preparation and administration of insulin is provided during educational sessions for diabetic patients.
Nutrition Advice for Children and Adolescents with Type 1 Diabetes
The educational sessions ought to include nutritional advice. The nutritional advice focuses on achieving blood glucose objectives devoid of extreme hypoglycaemia. The advice also focuses on achieving average growth and development, as well as lipid and blood pressure targets. These objectives can be attained through personalized meal planning and adaptable insulin routines and algorithms. These practices can be deeply rooted in patients by providing education and decision-making based on credentials and appraisals of previous outcomes.
Medical nutrition, which is a vital element in the control of insulin-dependent diabetes, is also one of the most difficult. The patients and their families need to consult a certified dietician with vast experience in paediatric nutrition and diabetes to guide the development of suitable meal plans. The meal plans ought to be tailored to ensure that favourite foods are included. In addition, the meals should be in line with the culture and schedule of the family and should match the child’s physical activities. The system should also be easy to execute within the family’s eating patterns.
Immunization
The presence of diabetes in children does not contraindicate any immunization. In addition, there is no known causal association between childhood immunizations and the onset of type 1 diabetes (Hviid, Stellfeld, Wohlfahrt, & Melbye, 2004). Therefore, these educational sessions advise parents to ensure that their children receive all the required immunizations.
Implementation of the Intervention
The implementation of patient education as a measure to manage juvenile type 1 diabetes can only be achieved with the help of various bodies. Successful outcomes can be realized with the help of organisations as well as local, national and professional bodies.
Local Implementation
A local diabetes network has been established in North West England as stipulated by the National Services Framework for Diabetes (Harwood, Mytton, & Watkins, 2004).
This network finds local leaders and chooses network managers, clinical champions and diabetic patients to champion the views of the local people. The network ensures the implementation of the education of diabetic children and adolescents. It also proposes changes to the established plans as deemed appropriate. A local diabetes list and research unit have been established to recognize main areas for future research in the improvement of diabetes services to the people of North West England.
Professional Implementation
The implementation of education for diabetic children and their families is carried out at the professional level by the health professionals that provide the education. These professionals include endocrinologists, dieticians, nurses, and mental health care professionals. These professional can help in the implementation of the educational program by scheduling appointments with the patients and their families once in a while to monitor the progress of the patient and advise accordingly.
For example, the incidence of hypoglycaemia should be established by a physician during every visit. A nurse practitioner should then assess for the unawareness of hypoglycaemia, which should be followed by a reassessment of blood glucose targets. A dietician can then advise the family accordingly on the meals that maintain the required blood glucose levels.
National Implementation
National initiatives such as “Saving Lives: Our Healthier Nation” are in place to establish national paradigms and outline service models to promote health (Harwood, Mytton, & Watkins, 2004). Other organisations such as the British Society for Paediatric Endocrinology and Diabetes promote the education of paediatric endocrinology hence helping children and adolescents with type 1 diabetes.
The Department of Health in the UK has authorized the Research Division of the Royal College of Paediatrics and Child Health (RCPCH) to carry out a study to determine the population of diabetic children. Other organisations such as the Royal College of Nursing, the Association of Children’s Diabetes Clinicians and the NHS Diabetes among many others are also part of the study.
Organisational Implementation
Organisations such as Diabetes UK oversee endeavours to promote the education of children with diabetes to enable them to lead productive lives. This organisation ensures that strategies to educate diabetic children and teenagers are overseen by paediatricians with special interest in diabetes (Royal College of Paediatrics and Child Health, 2009).
The NHS undertakes local and national appraisal of diabetic services. The members of staff involved in the provision of care to diabetic patients undergo training to improve and advance their health care delivery skills. The profile also sees the recruitment of more staff members to improve the quality of services. In addition, the Local Workforce Development Confederation takes part in the development of learning and training curricula for diabetic patients (Harwood, Mytton, & Watkins, 2004).
Summary
Juvenile type 1 diabetes is a persistent form of insulin-dependent diabetes mellitus that manifests in children. The illness arises due to the failure of cells to take in glucose as a consequence of damage to the cells to absorb and utilize glucose due to the destruction of the pancreatic islets of Langerhans that secrete insulin. The hallmark indications of the symptom include the increased need for water, regular urges to pass urine and extreme food cravings.
In addition, there may be a lowered rate of wound healing, hypotension, low body temperature, an elevated heart rate, aches in the abdomen, queasiness, and vomiting. The existence of the classic diabetes indicators as well as a casual plasma glucose level that equals to or exceeds 200 milligrams per decilitre should be present for a clinician to make a diagnosis of diabetes. However, the outcomes need to be corroborated by a paediatric endocrinologist.
Type 1 diabetes causes far-reaching changes in the lives of children who are compelled to adapt to tedious medical regimens to enable them to lead healthy lives. However, the provision of education to the diabetic patients as well as their families has been shown to reduce the disease burden and help the affected people deal with the condition in a better way. In addition, this form of intervention improves the biophysical and psychological outcomes in juvenile type 1 diabetes by equipping the patients to manage their condition.
Northwest England is set apart by deprivation in comparison to other parts of England. It has been established that there is a direct link between deprivation and the increased prevalence of chronic conditions such as diabetes. The region comprises diverse ethnic groups including Asians and Blacks. Whites make up 94.4% of the population while the other ethnic groups make 5.6%. A large fraction of the North West population comprises of smokers, which elevates their risk of having insulin-dependent diabetes.
The total number of children under seventeen years living with type 1 diabetes in North West England by 2009 was 2,630 children out of the 1,498,716 of children under the age of 17 in the region. The prevalence of juvenile insulin-dependent diabetes was slightly lower than the expected incidence of 2,792.7 using the overall prevalence of type 1 diabetes in the entire country. The highest prevalence rates were recorded in North East Coast and South East England.
There exist various programmes in North West England that provide counselling and educational services to patients with type 1 diabetes and their families. These educational programmes include advice on proper nutrition, exercise activities and insulin administration to insulin to manage the amounts of sugar in the bloodstream. These services also equip children with adequate knowledge to take care of themselves independently.
The implementation of the education programmes is overseen at the local, national, professional, and organisational levels. Some of the bodies that aid the intervention of educational programmes in North West England include the “Saving Lives: Our Healthier Nation” initiative, the British Society for Paediatric Endocrinology and Diabetes, the UK Department of Health, Royal College of Nursing, the Association of Children’s Diabetes Clinicians, and NHS Diabetes.
In addition, the Research Division of the Royal College of Paediatrics and Child Health (RCPCH) continues to carry out studies to determine the population of diabetic children. At the professional level, diabetic care is provided by endocrinologists, dieticians, nurses, and mental health care professionals.
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