Paediatric T1D Guide
Paediatric T1D: Four Conversations Worth Having Early
A father walks into the children’s ward with a one-year-old who has been off her milk for two days. A sister-screening letter lands on the kitchen table four months after her brother’s diagnosis. A sixteen-year-old says nothing in clinic, then asks the nurse on the way out whether she will lose the team she has known since she was eight. The science behind each of these moments is now richer than it has ever been; the family conversation has not always caught up.
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Why this guide, and what it sits beside
Most paediatric content moves from the body outward: the immune system, the insulin, the device. This guide moves the other way. It sits with four moments families have lived through and asks what the evidence has to say about each one. The four moments are not the whole of paediatric T1D; they are the conversations that have changed most in the last decade and are still catching up to clinic practice in many places. The lifespan piece, what the four age bands actually look like and the trial-by-trial picture across them, lives in the Paediatric Lifespan Guide; this guide sits next to it, not over it.
Population averages get most of the way; the final twenty percent takes the family, the team, and the conversation. Every figure on this page is a starting point for a clinic discussion, not a target to hit alone.
How to use this guide
The three deep parts are designed to stand alone. Read in order if it helps; jump straight to the part that matches the conversation in front of your family if it does not. Each part anchors on the trial evidence, frames what changes in clinic practice, and closes with what the family can actually ask for.
Hub: Four Conversations Worth Having Early
This page. Why these four conversations, where the lifespan guide picks up, and how to navigate the cluster.
Part 1: DKA at Diagnosis, Why Infants Slip Through the Net
A third of children present in DKA at the moment they are diagnosed; under-1s carry the highest risk at around sixty percent. The textbook signs were written for older children, and screening with structured follow-up is the only intervention that has shifted the under-2s peak.
Part 2: Stage-2 T1D, the Decision That Did Not Used to Exist
Antibody screening identifies children years before clinical T1D arrives. For children at Stage 2 (multiple antibodies plus dysglycaemic OGTT), teplizumab can roughly double the time to clinical onset. The evidence is real, the access is uneven, and the conversation is new.
Part 3: Adolescent T1D and the Bridge to Adult Care
The canonical adolescent glycaemic dip is not a willpower problem. It is identity, sleep, exams, peer life, and a diabetes that does not pause for any of them. The bridge to adult care begins eighteen months before the actual transition; the leading indicator is quality of life, not HbA1c.
Companion guide: Children and Young People with T1D, the Lifespan View
The four age bands (infant under 2, preschool 2 to 6, paediatric 7 to 14, adolescent 15 to 17) with the trial spine for each, the family work distinctive to each, and the CGM-share handoff that moves with the child.
What carries across the four conversations
The thread that joins the four moments is something families already know in their bones. The body talks back honestly through the glucose, in every age band; what shifts is what the family can ask for, and how early they can ask. DKA at diagnosis is now also a screening question, not just a public-awareness question. Stage 2 has gone from a research category to a clinic decision. The four-band lifespan view (the focus of the companion guide) is now the international routing, not a UK quirk. The bridge to adult care begins long before the transition date in the calendar.
What does not change across any of this is that the family is the constant. The CGM share goes to the parent, then to the parent and the partner, then to the parent and the school, then to the young person and a slowly receding parent. The diabetes team is the second constant. Population-level evidence sits underneath every paragraph here, and population averages are most of the story, not all of it. The remaining piece is your child, and that is where the team and the family conversation come in.
Acknowledgements
This guide draws on the international paediatric T1D evidence base curated for GNL Grace, including the Cherubini 2020 international DKA-at-diagnosis cohort, the TEDDY screening programme, the TrialNet TN10 teplizumab pivotal (Herold 2019, Sims 2021), the Glaser and PECARN cerebral-oedema and fluid-management work, the Hilliard 2013 adolescent QoL prospective, the Wentzell 2022 PAID-EA validation, and ISPAD 2024 chapters 11, 12, 15, 16, 17, 21, and 23. Voice and structure follow the locked GNL writer specification. Thanks to the families at Birmingham Women’s and Children’s NHS Foundation Trust whose questions shape every page on this site.