Curriculum standards
Curriculum standards
Completion requirements
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Advanced Training in Endocrinology (Paediatrics & Child Health)
Knowledge guides
LG14: Disorders of glucose metabolism
Key presentations and conditions
Advanced Trainees will have a comprehensive depth of knowledge of these presentations and conditions.
Less common or more complex presentations and conditions
Advanced Trainees will understand these presentations and conditions.
Advanced Trainees will understand the resources that should be used to help manage patients with these presentations and conditions.
Epidemiology, pathophysiology, and clinical sciences
Advanced Trainees will have a comprehensive depth of knowledge of the principles of the foundational sciences.
Investigations, procedures, and clinical assessment tools
Advanced Trainees will know the scientific foundation of each investigation and procedure, including relevant anatomy and physiology. They will be able to interpret the reported results of each investigation or procedure.
Advanced Trainees will know how to explain the investigation or procedure to patients, families, and carers, and be able to explain procedural risk and obtain informed consent where applicable.
Important specific issues
Advanced Trainees will identify important specialty-specific issues and the impact of these on diagnosis and management and integrate these into care.
Presentations
- Asymptomatic with detection on screening
- Diabetic ketoacidosis
- Failure to thrive
- Fatigue
- Hyperglycaemia hyperosmolar state
- Hypoglycaemia in neonates and children
- Polydipsia
- Polyuria
- Visual changes
- Weight loss
Conditions
- Cerebral oedema
- Diabetes mellitus:
- cystic fibrosis-related
- drug induced:
- chemotherapy
- steroids
- monogenic
- neonatal
- type 1
- type 2
- Diabetic ketoacidosis
- Diabetes secondary to other conditions, such as:
- congenital absence of the pancreas
- pancreatectomy
- pancreatic insufficiency
- post-transplantation
- recurrent pancreatitis
- Hyperinsulinism:
- congenital
- permanent
- transient
- Hypoglycaemia:
- childhood
- neonatal
- Metabolic syndrome
- Pre-diabetes
For each presentation and condition, Advanced Trainees will know how to:
Synthesise
- recognise the clinical presentation
- identify relevant epidemiology, prevalence, pathophysiology, and clinical science
- take a comprehensive clinical history
- conduct an appropriate examination
- establish a differential diagnosis
- plan and arrange appropriate investigations
- consider the impact of illness and disease on patients and their quality of life when developing a management plan
Manage
- provide evidence-based management
- prescribe therapies tailored to patients' needs and conditions
- recognise potential complications of disease and its management, and initiate preventative strategies
- involve multidisciplinary teams
Consider other factors
- identify individual and social factors and the impact of these on diagnosis and management
Conditions
- Atypical forms of diabetes
- Genetic syndromes of severe insulin resistance and/or insulin deficiency
- Rare syndromes associated with increased diabetes risk
- Total pancreatectomy and auto-islet transplant
For each presentation and condition, Advanced Trainees will know how to:
Synthesise
- recognise the clinical presentation
- identify relevant epidemiology, prevalence, pathophysiology, and clinical science
- take a comprehensive clinical history
- conduct an appropriate examination
- establish a differential diagnosis
- plan and arrange appropriate investigations
- consider the impact of illness and disease on patients and their quality of life when developing a management plan
Manage
- provide evidence-based management
- prescribe therapies tailored to patients' needs and conditions
- recognise potential complications of disease and its management, and initiate preventative strategies
- involve multidisciplinary teams
Consider other factors
- identify individual and social factors and the impact of these on diagnosis and management
Screening for diabetes complications and associated conditions
- Diagnostic criteria
- Macrovascular complications:
- blood pressure
- lipids
- Microvascular complications
- nephropathy
- neuropathy:
- autonomic (e.g. gastropheresis)
- peripheral
- retinopathy
- Monitoring glycaemia:
- daily targets according to subtype of diabetes
- long-term targets:
- glucose homeostasis
- prevention / slowing of progression of diabetes and its complications with management, monitoring, and screening
- mean glucose
- time in range for continuous glucose monitoring
- Other:
- diabetes distress
- myopathy
- obstructive sleep apnoea
- screening for disordered eating
- Other associated metabolic screening, such as:
- fatty liver disease
- Additionally and specifically for type 1 diabetes:
- autoimmune adrenal insufficiency, including autoimmune polyglandular syndrome
- coeliac disease
- thyroid disease
Insulin dose adjustments (irrespective of insulin delivery method)
-
Safe dose adjustments in response to:
- alcohol and other drugs
- blood glucose levels
- exercise
- fasting
- nutrition
- perioperatively and periprocedurally
- sick days
- travel / flying
- Treatments that impact blood glucose, such as glucocorticoids and parenteral nutrition
Lifestyle
- Counselling and best evidence-based lifestyle advice for individuals to manage all forms of established diabetes, and prevent the development of type 2 diabetes
- Safe dose adjustments in response to:
- alcohol / other drugs
- carbohydrate counting
- cardiovascular risk mitigation
- contraception and pre-conception planning
- education and employment
- exercise
- nutrition and diet
- smoking / vaping
- weight management
Pharmacological therapy
- Knowledge of the pharmacological therapy indicated for:
- hyperinsulinism
- monogenic diabetes
- pancreatectomy or endocrine pancreatic insufficiency
- type 1 diabetes mellitus
- type 2 diabetes mellitus
- Mechanisms of action of major drug classes in:
- hyperinsulinism:
- diazoxide
- somatostatin analogues
- other
- glycaemia:
- effects of concurrent drug therapies on glycaemia
- insulins
- non-insulin injectable drugs
- oral hypoglycaemic drugs
- use of medications for evidence-based benefits beyond glycaemia in people living with diabetes
- hyperinsulinism:
- Medication management plans
- Principles of pharmacology:
- drug distribution, metabolism, and excretion
- drug interactions, precautions, and contraindications
Diabetes diagnosis screening
- Pancreatic autoantibody screening
- Genetic screening, and when it is appropriate for suspected inherited forms of diabetes
- Assessment of endogenous insulin reserve:
- glucose
- HbA1c, fructosamine
- C-peptide
- oral glucose tolerance test
Diabetes complication screening
- 24-hour urine collection for proteinuria quantitation
- Cardiovascular risk mitigation, such as:
- blood pressure management
- lipid management
- weight management
- Gastric emptying study
- Glucose data interpretation
- Nerve conduction studies
- Retinal photographs
- Urine albumin / creatinine ratio
Neonatal hypoglycaemia and hyperinsulinism
- Complication management:
- investigate for pancreatic exocrine insufficiency in cases where pancreatectomy is required
- screening for diabetes in the future
- Hypoglycaemia screening, such as:
- beta hydroxybutyrate
- cortisol
- free fatty acids
- glucose
- growth hormone
- insulin
- Use of imaging modalities, such as:
- MRI
- PET scans
Advanced technology and devices in diabetes management
- Blood glucose monitoring systems:
- benefits, data interpretation, and limitations:
- bolus calculators for multiple daily injection (MDI)
- coefficient of variation (CV) targets
- mean glucose
- time in range
- continuous glucose monitoring (CGM) systems:
- concurrent with insulin pumps in manual mode or with automated insulin delivery
- MDI therapy
- finger prick meters – glucose and ketones
- bolus calculators
- benefits, data interpretation, and limitations:
- Continuous subcutaneous insulin infusion (CSII / ‘insulin pump’) therapy:
- calculation and adjustment of individuals’:
- basal insulin dose / rates
- carbohydrate ratio
- insulin sensitivity factor
- indications and suitability of CSII for an individual living with diabetes
- calculation and adjustment of individuals’:
- Insulin delivery devices:
- insulin pen devices for MDI therapy
- insulin pumps including automated insulin delivery
Evidence-based clinical practice
- Evidence for best practice and how it applies, using clinical judgement and individual circumstances in partnership with patients
- Principles, properties, indications for and limitations of beta cell transplantation, including whole pancreas or islet cell transplantation
- Principles, properties, indications for and limitations of immunotherapy agents for prolonging remission phase
General management considerations
- Educate, support, and empower people to self-manage their diabetes
- Environmentally sustainable practices in clinical care
- Equitable access to comprehensive diabetes care delivery for individuals, such as:
- appropriate multicultural resources
- multidisciplinary involvement
- use of telehealth and other digital health tools
- Equity of access to education, employment, and government for access to diabetes technology
- Impact of a diagnosis of diabetes and of living with diabetes on an individual, their family, their life, and their life stages
- Impact of cultural, health literacy, social, geographic, and financial barriers to accessing comprehensive diabetes care
- Impact of hypoglycaemia unawareness on patients, their family, and carers
- Impact of socioeconomic determinants of health on health outcomes
Health needs of adolescents with diabetes
- Assessment for medical clearance for driving
- Common risk-taking behaviour in young people, and its effects on diabetes
- Counselling regarding alcohol and other drugs in the context of diabetes management
- Counselling regarding contraceptives and safe sexual practices
- Physiological, psychological, and social factors affecting glycaemia in adolescence
- Physiological, psychological, and social problems of glycaemic maintenance in adolescence, and the concerns and anxieties of parents and/or carers
- Potentially negative effects of adolescent behaviour on diabetes, and the impact it may have on family and personal relationships
- Practitioner’s behaviour, and its impact on young people
- Transition adolescents to adult health care sensitively and safely