Guideline / position statementindependent cross-checkfull text checked★ key study I-INS-135 in-depth review
NICE guideline NG18: Diabetes (type 1 and type 2) in children and young people: diagnosis and management
NICE guideline NG18: Diabetes (type 1 and type 2) in children and young people: diagnosis and management
Overview
National Institute for Health and Care Excellence (NICE). NICE guideline 2015
UK paediatric guideline: insulin from diagnosis; DKA needs urgent hospital IV fluids and insulin; honeymoon phase is temporary.
Does the study support the specific claim? No · Methodological quality: high
Plain-language summary
Study explained simply
- What did the researchers want to find out?
National guidance.
- How was the study done?
Evidence-based guideline.
- How many people, animals or samples were studied?
Not applicable.
- What was actually found?
Rec 1.2.18: offer children and young people with T1D a multiple daily injection basal-bolus insulin regimen from diagnosis. Recs 1.2.82-1.2.83: sick-day rules including blood ketone monitoring; offer blood ketone strips and meter. Rec 1.4.3: children taking insulin may develop DKA with normal blood glucose. Rec 1.4.6: explain that DKA is serious and needs urgent hospital assessment. Rec 1.4.21: treat DKA with intravenous fluids and intravenous insulin if the child is not alert, nauseated/vomiting or clinically dehydrated. Rec 1.2.25: explain the partial remission ('honeymoon') phase with low insulin needs.
- How large was the observed effect?
Not applicable.
- What do the results mean in everyday life?
UK paediatric guideline: insulin from diagnosis; DKA needs urgent hospital IV fluids and insulin; honeymoon phase is temporary.
- What are the study's limitations?
Guideline.
- What does it say about Elawady's specific claim?
Contradicts insulin-free management.
- Do the results apply to Germany and Europe?
UK.
- What can explicitly not be concluded from this study?
Not applicable.
Scientific in-depth review
1. Full reference
- Authors
- National Institute for Health and Care Excellence (NICE)
- Journal
- NICE guideline
- Year
- 2015
- Identifier
- Verification
- verified – Recommendations page fetched 2026-10-26 (Published 1 August 2015; last updated 11 May 2023)
- Retracted
- no
- Corrections
- none
- Extent checked
- full text
- Conflicts of interest and funding
NICE (public body).
2. Research question
Diagnosis and management of diabetes
3. Study design and population
- Study design
- Guideline / position statement – National clinical guideline
- Population
People with diabetes in England/Wales
- Country
United Kingdom
- Period
Published 1 August 2015; last updated 11 May 2023
- Sample size
Not applicable
- Inclusion and exclusion criteria
Not applicable
4. Methods and endpoints
- Exposure / intervention
Not applicable
- Comparator
Not applicable
- Endpoints
Recommendations
- Statistical methods
Not applicable
5. Actual results
- Results
Rec 1.2.18: offer children and young people with T1D a multiple daily injection basal-bolus insulin regimen from diagnosis. Recs 1.2.82-1.2.83: sick-day rules including blood ketone monitoring; offer blood ketone strips and meter. Rec 1.4.3: children taking insulin may develop DKA with normal blood glucose. Rec 1.4.6: explain that DKA is serious and needs urgent hospital assessment. Rec 1.4.21: treat DKA with intravenous fluids and intravenous insulin if the child is not alert, nauseated/vomiting or clinically dehydrated. Rec 1.2.25: explain the partial remission ('honeymoon') phase with low insulin needs.
- Absolute risks
not applicable
- Authors' conclusion
UK paediatric guideline: insulin from diagnosis; DKA needs urgent hospital IV fluids and insulin; honeymoon phase is temporary.
6. Strengths
- Current, evidence-graded recommendations
7. Weaknesses
- Consensus elements; partly expert opinion
8. Risk of bias
- Orienting tool
- none applicable
- Type of assessment
- simplified assessment (abstract only)
- Full formal assessment
- no
- Overall risk of bias
- not assessable
- Rationale
Guideline; graded recommendations from systematic evidence review.
9. Assessment of the statistical interpretation
Not applicable
10. Relevance to the specific claim
UK paediatric guideline: insulin from diagnosis; DKA needs urgent hospital IV fluids and insulin; honeymoon phase is temporary.
11. Independent contrary findings
12. Transferability to Germany and Europe
UK guideline; consistent with European practice.
13. Overall methodological judgement
Authoritative national guideline.
| Multidimensional assessment | |
|---|---|
| Authenticity of the source | verified |
| Methodological quality | high |
| Risk of bias | not assessable |
| Precision of results | not applicable |
| Directness | direct |
| Reproducibility | unknown |
| Consistency with the overall evidence | consistent |
| Regional transferability | high |
| Adequacy of the interpretation (by the archive) | not applicable |
14. Open questions
15. Linked fact checks
- Diabetic ketoacidosis (DKA) does not kill anyone; it should be treated with corticosteroids and complete fasting from food and drink for days, without insulin and without intravenous fluids; giving insulin in this situation is 'the black disaster'. – Studies contradicting or limiting the claim
- There is no such thing as type 1 diabetes; 'type 1' is a state of high sugar seen mainly in athletes with high needs; type 1 patients do not develop complications; insulin before puberty is a catastrophe (short stature, thyroid problems, cysts). – Studies contradicting or limiting the claim
- Laboratory values such as blood glucose and acetone are only signs of the body's changing strategy and not causes; there is no need to measure glucose or blood pressure. – Studies contradicting or limiting the claim