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This chapter has been updated with additional details and references on educational approaches for multidisciplinary teams, including cultural adaptation, as well as a section on type 2 diabetes (T2D) in youth. Diabetes education and digital technologies as well as telemedicine, with increased adoption of video or phone appointments, has also been expanded and enhanced. To maintain quality diabetes management, families perform a multitude of self-management tasks daily, responding to changes in activity, food, and physiology. The challenge for diabetes health care professionals is to deliver diabetes education that optimizes the family's knowledge and understanding of the condition and its treatment, while simultaneously assisting them to adjust to the impact of diabetes management on their everyday lives. In addition, parents need to combine managing their child's diabetes-related tasks alongside their usual parenting responsibilities. This challenge is even greater in low- and middle-income countries where limited resources may threaten access to insulin, food security, and the availability of the basic tools to manage diabetes such as glucose and ketone monitoring equipment. Diabetes education is a critical element of diabetes care, regardless of the intensity of the insulin regimen adopted. Diabetes management requires frequent and high levels of educational involvement at diagnosis and ongoing to support the children and adolescents as well as parents and other care givers.1, 2 This evidence informed guideline has been adapted and updated with the aim to describe universal educational principles, details regarding content, and organization of diabetes education in children and adolescents and provide consensus recommendations.3 Many countries have developed their own set of guidelines, appropriate for their health services and cultural backgrounds.4-13 “Diabetes education is an interactive process that facilitates and supports the individual and/or their families, caregivers or significant social contacts to acquire and apply the knowledge, confidence, practical, problem-solving and coping skills, needed to manage their life with diabetes to achieve the best possible outcomes within their own unique circumstances.”14 Regardless of insulin regimen used, the complexity of diabetes treatment requires that children with diabetes and their caregivers make numerous daily treatment decisions, necessitating empowerment of the child or adolescent and their caregivers. Empowerment in health care is defined as a motivational approach to assist people to make health-promoting behavior choices and/or changes.15 In the field of diabetes, empowerment is defined as the process of helping people discover and use their innate ability to gain mastery over their diabetes.16 The approach is person-centered with the health care providers facilitating and providing information and knowledge to assist people in making informed decisions. Persons with diabetes should be empowered to know that they ultimately influence their own lives in making informed decisions about their diabetes. Children and adolescents with diabetes need to have age-appropriate understanding of diabetes and be empowered to participate in the management of their diabetes.4-7, 16, 17 Every young person with diabetes should have access to comprehensive structured education to help empower them and their families to manage their diabetes in an age-appropriate manner.4, 6, 9-13, 18 In addition to the child or adolescent and their primary caregivers, other care providers should have access to educational resources and staff and be included in the educational process.8, 19 Caregivers in nurseries or kindergarten and school teachers should have access to appropriate structured diabetes education.20-22 Educational programs should utilize appropriate person-centered, interactive teaching methods for all people involved in the management of diabetes. This approach must center around the child or adolescent with diabetes,4-8, 11-13, 18 and be adaptable to meet the different needs, personal choices, individualized learning styles of young people with diabetes and their parents, in the context of local models of care. Diabetes education needs to be personalized to the individual's age, stage of diabetes, maturity and lifestyle, culture and learning pace.4, 6, 11, 12 The sharing of roles and responsibilities for the diabetes treatment tasks between the child or adolescent and their caregivers should be continuously clarified and considered in relation to the need for education.23, 24 This personalized diabetes educational approach remains an integral part of the psychosocial support for young people with diabetes and their families. Diabetes education should be delivered by a multidisciplinary team of health care professionals who have a clear understanding of the special and changing needs of young people and their families as they transition through the different stages of life.4, 7, 8, 11, 25 Multidisciplinary teams providing education should include, at a minimum, a pediatric endocrinologist/diabetologist or a physician trained in the care of children and adolescents with diabetes, a diabetes specialist nurse/diabetes educator/pediatric nurse, and a dietitian. Furthermore, a psychologist, a social worker or a team member trained in mental health are recognized as essential members of the multidisciplinary team.6 In areas with limited resources, it is not always possible to have all members of a multidisciplinary team and additional details are provided in the chapter “Limited Care Guidance” (2022 Consensus Guidelines Chapter 25 on Management of diabetes in children and adolescents in limited resource settings). Educators in the multidisciplinary team must take responsibility for maintenance of their professional development to remain up to date with their knowledge and skills. They should have access to continuing specialized training in current principles of insulin therapy, new diabetes technologies, advances in diabetes education, and educational methods as well as client engagement.4, 6, 8, 11, 12, 26, 27 Cultural adaptation has been described as the modification of educational approaches to consider language, culture, and context in such a way that it is compatible with the client's cultural patterns, meaning, and values.28 Due to increased mobility and migration, cultural and language differences may hinder communication and diabetes education. It is recommended that diabetes education is provided with professional translator services if appropriate, and educational material is offered in the family's native language where available.29 Diabetes education needs to be a continuous process and be repeated on a regular basis for it to be effective.4-8, 11, 12 The priorities for health care professionals in diabetes education may not match those of the child and the family. Thus, diabetes education should be based on a thorough assessment of the person's attitudes, beliefs, learning style, learning ability, readiness to learn, existing evidence, knowledge, and goals.30 Table 1 summarizes the philosophy of diabetes education in children, adolescents, and their parents.4, 8, 31, 32 The knowledge base for some key universal principles is explained in the following sections. All members of the multidisciplinary diabetes team take part in delivering diabetes education. In the initial phase this will encompass key messages that include; (1) informing young people and their families that they have developed diabetes; (2) initiating diabetes education to explain and/or answer the many questions that arise immediately after receiving the diagnosis; (3) informing the child, adolescent, and their primary caregivers about current “best practices” for the management of diabetes; (4) information about how the young person, their family and support network can promote self-management of their diabetes after initial education and instruction. To maximize the impact of education, a diabetes health care service must formally design what they need to teach and what the young person and family need to learn. A diabetes health care service for young people needs to develop their own, culturally appropriate: Diabetes education curriculum: a detailed list of contents or subjects to be taught by the health professional and learnt by the young people with diabetes and their families. Diabetes education syllabus: instructions on the delivery, depth of learning and learning outcomes, considering the needs of the person with diabetes, with content of different subjects and methods. Learning outcomes are “statements that describe the knowledge or skills students should acquire by the end of a particular assignment, class, course, or program, and help students understand why that knowledge and those skills will be useful to them.”33 National and regional programs9-12 can and often are adopted by local health services, with sharing of educational resources from other centers, reliable external sources, diabetes support group organizations, and medical societies. Each Multidisciplinary Diabetes Team needs to construct its own approach to their diabetes education program, based on their health professional numbers, the scope of their health provision resources and social structure of their health environment (Table 2). A check-list approach has been adopted at most diabetes centers, allowing aspects of the education program to be introduced at a manageable pace for the person with diabetes and with allocation of certain learning tasks to different members of the multidisciplinary team based upon their individual expertise. Insulin action and profile Adjustment of insulin Pump extended bolus functions Introduction to diabetes technology (if available) Revise frequently Goal setting focus on goals that are SMART: specific, measurable, achievable, realistic, and time-based Micro- and macro-vascular complications, screening protocol, and prevention Focus on basic survival skills needed to manage diabetes from day one. Accomplishment of these skills will increase the caregiver's and child's confidence in their ability to manage. Assess competence in Basic dietetic advice including carbohydrate counting, importance of healthy eating, and meal-time routines. Promotion of healthy body weight. Clarification of myths about food and diabetes, as well as beliefs about cure in the honeymoon phase. Explain effect on glucose levels of different food components including protein, fat, fiber, and glycemic index; and discuss insulin therapy management strategies to optimize postprandial glucose levels Revise nutritional skills as the child grows and develops Adapt nutritional interventions in response to new diagnosis, for example, celiac disease Screen for disordered eating Explanation of hypoglycemia (symptoms, prevention, management), identify cards, bracelet, necklace. Explanation of hyperglycemia and diabetes ketoacidosis (symptoms, prevention, management). Revise with introduction of new activities and new caregivers Practice reconstitution of glucagon Risk factors: hypoglycemia unawareness, young age Precautions with alcohol, and driving Effect of intercurrent illness, hyperglycemia, ketosis, and prevention and identification of DKA Diet and fluids of sick days Sick day management plan (see chapter: Sick day management) Problem-solving and adjustments to treatment in everyday life, motivation, and coping with unexpected glucose fluctuations Review and revise school management plan annually Exercise, camp, holiday planning, and travel Information to teenagers about alcohol, tobacco, cannabis, and other illegal recreational substances (see chapter about adolescents) Information about contraception, sexuality, and pregnancy planning Information about employment A completed checklist does not necessarily mean that the young person with diabetes and the family have learned everything they need to know as diabetes education is not a “one off” process. Diabetes education requires constant review, depending on the needs of the person with diabetes and the family with ongoing maturation and adaptation. Many centers will give Education Updates at appropriate times that may include annual assessments with clinical review, starting or changing school, during the adolescent period, at the adoption of new diabetes technologies or with any dietary changes. The evidence-base for the effectiveness of structured education versus informal unstructured education in improving glycemic control34-36 and preventing severe hypoglycemia and restoring awareness of hypoglycemia37 comes mainly from studies involving adults with diabetes. These studies have been performed mainly in North America, Australia, and Europe and have been extensively reviewed in various publications.6, 8, 34 Diabetes self-management education programs are efficacious and cost-effective in promoting and facilitating self-management, improving children's diabetes knowledge, skills, and motivation, and have been shown to improve biomedical, behavioral, and psychosocial outcomes.38 There are few studies involving children and adolescents with type 1 diabetes (T1D) and their parents, and the evidence base for the effectiveness of structured education programs is limited.6, 8, 39, 40 Indirect evidence suggests that countries in which structured education are available for all have better outcomes with respect glycemic control.41-43 Evidence to assess the impact of a structured education program in children with T1D, suggest that the structured education and support program in the year after diagnosis can improve short-term glycemic outcomes, measured as HbA1c, but this effect may not persist after discontinuing intensive coaching. This highlights the need for ongoing person-centered education.44 A short-term (1 year) evaluation of a structured initial education program improved child and parent-reported outcomes.40 Structured education should be available to all persons with diabetes at the time of diagnosis and reinforced with regular teaching sessions after diagnosis and then annually or more frequently as determined by formal, regular individual assessment of need.4-12 A review of relevant qualitative studies in pediatric and adolescent services showed that providing skills training using structured education to people does not necessarily result in participants adopting and sustaining recommended changes in behavior. To sustain diabetes self-management skills after attending structured education, it is recommended that support be provided over the longer-term by appropriately trained health care professionals in response to individuals' needs.6, 27, 45 A study of structured education during the pediatric to adult transition period highlighted the importance of carbohydrate counting in predicting glycemic control.46 This study emphasized that many persons diagnosed and educated in childhood may be more knowledgeable in diabetes management, but their practical skill in matching insulin dose and carbohydrate content is often suboptimal.46 Effective educational programs are carefully planned, have specific aims and age-appropriate learning objectives, which are shared with people with diabetes, their families, and other care givers4, 6, 8, 17, 47 and are integrated into routine care. Ways to improve access to and uptake of diabetes self-management programs are needed globally in resource deficient regions.38 Many less-resourced countries, which have a high rates of morbidity and mortality, may only be able to provide minimal education and ongoing support. All young people with T1D and their caregivers deserve quality care, with structured diabetes education from a diabetes team or health care professional experienced in pediatric diabetes.48 The interpretation of educational research is complex relating to the intersection of interventions frequently education, and The outcomes most to be by diabetes education are knowledge and self-management and psychosocial These psychosocial and outcomes are key for glycemic of interventions that such have shown to on glycemic and a greater effect on The are more for children for a of support methods have been in with defined education programs that include motivational life and a all of these approaches to improve the and coping strategies of young is often minimal in glycemic measured as In addition, the impact is often of repeated high glycemic and glycemic may be with the it is to of hypoglycemia and time in if glycemic Education may be as an between clinical and research into diabetes and educational methods is in improving clinical and should be by diabetes centers, as well as part of and and 12, Diabetes education is delivered by all members of the diabetes multidisciplinary team who other by within their scope of as by their All team members are for the educational needs of the family at of and to the most appropriate diabetes health care professional to the family's learning 11, 12, 25 The team should have a understanding of the principles teaching and The diabetes team should skills with the principles of teaching and structured education and also management including into their 27 diabetes education and clinical management are available in some countries with programs available to health care professionals to achieve diabetes in clinical diabetes education, and and frequently manage the delivery, and evaluation of education programs within their health Guidelines should be developed and for for diabetes to help quality education is provided to young people with diabetes and their Multidisciplinary teams providing education should include, at a minimum, a pediatric endocrinologist/diabetologist or a physician trained in the care of children and adolescents with diabetes, a diabetes specialist nurse/diabetes educator/pediatric nurse, a a psychologist, and a social professionals such as a or a can an in the diabetes team by providing of children and young people for and and support in the educational process for the child with diabetes, parents, and Furthermore, an can provide and practical to children and adolescents with In addition, is in trained health or life in helping people with diabetes meet self-management diagnosis families may be to education to the of the diagnosis or for practical such as from to this the education program should be to meet the pace by the family's readiness to learn. 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