Diabetes education in children and adolescents.

Education is the keystone of diabetes care and structured self-management education is the key to a successful outcome. Adapted from (1) National pediatric guidelines emphasise the importance of education, but do not include specific chapters on education and educational principles (2–5). Publications which provide useful guidelines on education in diabetes include ‘‘National Standards for diabetes self-management education (DSME)’’ (6), ‘‘Position statement on structured education’’ (7), ‘‘Guidance on the use of patient-education models for diabetes’’ (8), the ‘‘International Curriculum for Diabetes Health Professional Education’’ (9) and a recent description of paediatric diabetes education in Germany (10). See end of text. A definition of Diabetes Education has been proposed: ‘‘The process of providing the person with the knowledge and skills needed to perform diabetes selfcare, manage crises and to make lifestyle changes to successfully manage the disease’’. (11) Education may be seen as an interface between clinical practice and research. Research into diabetes and educational methods is important in improving clinical practice (2, 5, 6, 11, 12) and this should be the responsibility of each nation / state and be a national priority (7, 10, 13). Educational programmes must be carefully planned, have specific aims and learning objectives, which are shared with people with diabetes, carers and their families (8, 10). It has remained contentious whether educational interventions per se are beneficial in diabetes care, particularly in children and adolescents because ‘‘educational, psychosocial and psychotherapeutic interventions are frequently combined for the purpose of improving knowledge, skills and self-efficacy across various aspects of diabetes self-management’’ (14). Nevertheless, systematic reviews of psycho-educational interventions conclude that they have small to medium beneficial effects on glycemic control (14, 15) and somewhat greater effect on psychological outcomes (16). The effects are greater for children than adults (16), and are most effective when integrated into routine care, when parents are involved, empowerment principles are involved, problem-solving, goal setting and self-efficacy is promoted (10, 15, 17). The DCCT provided unequivocal evidence that intensification of management reduces micro-vascular complications and that intensification requires effective diabetes self-management. Most importantly, effective self-management requires frequent and high levels of educational input and continuing support (6, 10, 11, 12, 18, 19). Related to this is evidence that health care professionals engaged in education who are perceived by young people as being ‘‘motivating’’ may encourage greater adherence to therapy (20). This high level of motivation and enthusiasm in educational intervention is likely to improve biomedical outcomes by itself and