An intensive diabetes management program for young children under seven years of age has resulted in 83% of patients achieving target HbA1c.

The 2016 data from the John Hunter Children’s Hospital represents a considerable improvement in rates of glycaemic control – up from 31% in 2004 when the program was introduced and 64% in 2010.

It is also significantly more impressive than the 34% reported in a similar age group in a national audit last year.

Helen Phelan, a clinical nurse consultant and nurse educator in the Hospital’s department of paediatric endocrinology and diabetes, told the limbic one of the pillars of the program was the use of a bolus insulin calculation card (BICC) for parents of children on injection therapy.

“Pumps are fabulous for delivering very small amounts on insulin and you can dilute insulin, and it can suit very small children very well. But it’s actually not something available to all patients – as a large proportion of families are without private health cover.”

“So we started working really hard with our MDI as well to try and make that more acceptable to the families. And a major part of that was using the BICC dosage card, which is unique to Newcastle. It’s a bit like a poor man’s pump – so where the pump has individualised settings for the patients, we replicate that in this card.”

Ms Phelan said another important aspect of their program was the very structured approach to eating.

“Prior to using this program, people were very frightened to give insulin before a meal because a young child will often refuse food and that is a scary prospect for families. So we really work with families to understand the effect of insulin and include a lot of education around participation in family mealtimes and taking the stress away from meals – that they’ve got two to three hours to observe and monitor the child.”

Parents are also encouraged not to let children snack on food all day, which was the fear-based approach to try and prevent hypoglycaemia.

She added it was not clear why some children did not achieve target despite intensive management.

“Is it some underlying factor that you can’t control for or is there a little more chaos in that family? I’m not sure.”

“But what we do is work with the modifiable factors that we know will help so consistency of giving injections, always giving insulin before you eat, alleviating fears around hypoglycaemia, educating parents to be more comfortable with the normal blood glucose range, etc.”

“Of course there are families that find that incredibly challenging and there will be psychological barriers where people may have a past experience with hypoglycaemia.”