As we commemorate the 50th anniversary of the International Society for Pediatric and Adolescent Diabetes (ISPAD), it is important to reflect on the dynamic relationship between continuity and change for the latest updated version of the ISPAD Clinical Practice Consensus Guidelines (CPCG). The ISPAD guidelines represent a rich repository that serves as the only comprehensive set of clinical recommendations for children, adolescents, and young adults living with diabetes worldwide. This 2024 CPCG Update marks the 7th iteration, with succeeding editions from 1995, 2000, 2009, 2014, 2018, and 2022. Over the years, the CPCG have evolved to embrace innovations in glycemic monitoring, medications, and their delivery, foster cultural awareness, and emphasize optimal care across a broad range of healthcare systems and models. Recent editions have also incorporated more diverse authorship perspectives, increasing geographic and multidisciplinary representation, as well as adding individuals with firsthand diabetes experience.
The 2024 CPCG Update features six high-impact chapters in rapidly evolving areas, including advancements in technology (insulin delivery and glucose monitoring), innovations in screening, early-stage monitoring and prevention of type 1 diabetes, insulin and adjunct-to-insulin treatments, management of type 2 diabetes, and glycemic targets. Each chapter was written with the invaluable input of persons with lived diabetes experience. What is less visible is that the update process was also substantively changed to improve rigor. A comprehensive literature search methodology approach was implemented. This ensured a thorough review of recent, relevant studies, enhancing each guidelines’ evidence base, along with a structured screening and review process to ensure accuracy and minimize bias. Chapters were also written more concisely for ease of reference, with content and recommendations designed to address clinically important questions related to detection, prognosis, prevention, and management. They also feature an added emphasis on harmonized graphics and visualization to display information, enabling guidance on the best practices for care of children and young people living with diabetes. These changes will continue to inform future ISPAD CPCG development and dissemination.
These guidelines are also being published in a new journal, Hormone Research in Paediatrics. ISPAD remains committed to maintaining open accessibility of these valuable CPCG to healthcare professionals globally, in multiple languages.
Yet even these updated CPCG reflect challenges for the diabetes practice community. We must strive to transition from the predominance of recommendations that are based upon expert consensus grading (“E” grade recommendations) and increase the availability of high-quality clinical evidence. We must also continue to address disparities in outcomes and the challenges faced by persons living with diabetes with limitations in access and resources to support optimal care.
Overall, this 2024 ISPAD Update adds to the longstanding ISPAD CPCG tradition of collating and sharing best practices with a global audience of persons living with diabetes and their healthcare teams. Being true to this mandate ensures that clinical practice guidelines are developed in a rigorous manner, are clear and concise so that they can guide practice, reduce the burden of diabetes management, optimize quality of life, and are freely accessible globally to facilitate effective implementation. The guidelines are a cornerstone of ISPAD’s mission to advance clinical care, research, education and advocacy, to improve the lives of children, adolescents, and young adults living with diabetes.
Conflict of Interest Statement
F.H.M. received research support from the Canadian Institute for Health Research (CIHR), Physicians Services Incorporated, Heart and Stroke Foundation, Diabetes UK, and Breakthrough Diabetes (formerly JDRF). K.D. received honoraria for participation in the speaker’s bureau of Abbott, Eli Lilly, Medtronic, Novo Nordisk A/S, and Pfizer and advisory board for Medtronic and Novo Nordisk. C.E.S. received speaker honoraria from Medtronic and Eli Lilly and advisory boards for Abbott. M.L.M. and L.P. have no conflicts of interest to declare. L.A.D. received research support from the NIH, JDRF, and the Helmsley Charitable Trust. Her institution has received research support from Dompe, Lilly, Mannkind, Medtronic, Provention Bio, Sanofi, and Zealand. She has consulted for Abata, Tandem, Biomea Fusion, and Vertex. She also received payment from Sanofi for a CME talk (content independently developed by L.A.D.).
Funding Sources
The 2024 Consensus guidelines were supported by unrestricted grants from Abbott Diabetes Care, Dexcom, Medtronic, and Sanofi. These companies did not take part in any aspect of the development of these guidelines.
Author Contributions
F.H.M. and L.A.D. serve as Chief Editors and co-led the 2024 ISPAD CPCG chapter development process. K.D., C.E.S., M.L.M., and L.P. serve as Associate Editors and revised the initial manuscript and approved the final version.