what is change management methodology

Updated: 19 March 2024 Contributors: Alexandria Iacoviello, Amanda Downie

Change management (CM) is the method by which an organization communicates and implements change. This includes a structured approach to managing people and processes through organizational change.

A change management process helps ensure that employees are equipped and supported for the entirety of the transition. Several reasons constitute a need for change management. Mergers and acquisitions, leadership adjustments and implementation of new technology are common change management drivers. The organizational development needed to compete with rapid digital transformation across the industry leads companies to implement new products and new processes. However, these innovations often disrupt workflows, presenting a need for effective change management.

Successful transformational change goes beyond a communication plan; it involves implementing change throughout the company culture. A change management strategy can help stakeholders to adopt proposed changes more readily than in situations where such a strategy is not employed. By activating employees as change agents by involving them in the workflow, business milestones can be achieved. Leaders can and should establish the benefits of change through developing a comprehensive change management plan.

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Change management should be a thought-out, structured plan that remains adaptable to potential improvements. How change leaders choose to approach organizational change management varies in size, need and potential for employee buy-in.

For example, employees who lack change efforts experience may need a more tailored approach, like receiving guidance from human resources  (HR). Employees who experience change on an organizational level may serve as good candidates on the change management team, offering insightful support to leadership and fellow employees.

Successful change management is a cumulative result of all the key stakeholders’ success in understanding the change initiatives. This requires proactively engaging and supporting a positive employee experience —invite employees to give constructive feedback and continuously communicate the business process or scope changes.

Psychologists and change leaders have developed several methods of organizational change management:

Developed by change consultant William Bridges  (link resides outside ibm.com), this framework focuses on people’s reactions to change. The adjustment of critical stakeholders to change is often compared to the five stages of grief, but instead, the Bridges’ model is described through three stages:

• Endings: The discontinuation of old processes.
• Neutral zone: The uncertainty and confusion as new roles are being identified.
• New beginnings: The acceptance of new ways.

Owned by a joint venture between Capita and the UK Cabinet Office, Axelos developed the IT Infrastructure Library (ITIL) . The framework uses a detailed guide to manage IT operations and infrastructure. The goal is to drive successful digital transformation through incident-free IT service implementation throughout the change management process.

Over the years, ITIL was improved and expanded upon to enhance the change process. The ITIL framework has four versions, with the latest being ITIL v4. This version prioritizes the implementation of proper DevOps , automation and other essential IT processes. 1  Created to aid in modern-day digital transformation, the Fourth Industrial Revolution prompted ITIL v4.

John Kotter, a Harvard professor, created his process for professionals that are tasked with leading change. 2  He collected the common success factors of numerous change leaders and used them to develop an eight-step process:

• Creating a sense of urgency for change.
• Building a guiding coalition.
• Forming a strategic vision and initiatives.
• Enlisting a volunteer army.
• Enabling action by removing barriers.
• Generating short-term wins.
• Sustaining acceleration.
• Instituting change.

Psychologist Kurt Lewin developed the "unfreeze-change-refreeze" framework during the 1940s. 3  The metaphor implies that the shape of an ice block remains unaltered until it shatters. However, transforming an ice block without breaking it can be done by melting the ice, pouring the water into a new mold and freezing it in the new shape. Lewin drew this comparison for change management strategy, indicating that introducing change in stages can help an organization successfully attain employee buy-in and a smoother change process.

In the late 1970s, McKinsey consultants Thomas J. Peters and Robert H. Waterman wrote a book called In Search of Excellence . 4 In that book, a framework was introduced through its ability to map out interrelated factors that can influence the ability of an organization to change. Around 30 years later, this framework became the McKinsey 7-S Framework. The intersection of the elements within the framework differs depending on the culture or institution. Listed in no hierarchical order, those seven elements are:

• Shared values

The Prosci Methodology, developed by the firm Prosci, is based on various studies that examine how people react to change. The methodology comprises three main components: the Prosci Change Triangle (PCT), the ADKAR model and the Prosci 3-Phase Process.

Sponsorship, project management and change management drive the PCT Model framework. This model puts success at the center of these three elements and is used in the overall Prosci Methodology.

ADKAR Model

The ADKAR model addresses one of the most essential change management pieces: the stakeholders. The framework is an acronym that equips change leaders with the right strategies:

• Awareness of the need for change.
• Desire to participate and support the change.
• Knowledge of how to change.
• Ability to implement desired skills and behaviors.
• Reinforcement to sustain change.

The Prosci 3-Phase Process

A 3-phase process that has a structured but flexible framework. The three phases of the Prosci Methodology are to prepare an approach, manage change and sustain outcomes. 5

Stakeholders can vary depending on the size of the organization and the nature of change. For example, if you are changing a process that directly impacts a product you offer clients, then your clients are essential stakeholders. Whereas if you are changing an internal technology tool, your clients might not be critical stakeholders.

To determine the stakeholders necessary for your change management strategy, define the scope of change first. Next, determine who consistently uses and operates these current processes. Begin by engaging those stakeholders; as you go, it may be determined that there are more key stakeholders to consider. As discussed, it is important to be flexible with adjusting your change management process. Additional stakeholders may need to be included in the change management strategy at different stages.

Common stakeholders in change management are typically executives and leadership, middle managers, front-line employees, developers, project managers, Subject Matter Experts (SMEs) and potentially, clients. To identify the stakeholders involved in change management, consider asking these questions:

• Who leads the business unit undergoing change?
• Who owns the process undergoing change?
• Who are the people sponsoring change?
• Who are the people executing change?
• Who are the people most affected day-to-day by the change?

With the advent of rapid digital transformation and continual innovation, change management is a crucial tool for organizations to succeed. Among the various methodologies of change management are some best practices to consider:

• Clearly define the vision and make goals measurable.
• Ensure employee buy-in is as important as executive sponsorship.
• Be willing to adjust your process, especially if it is not driving the coveted outcomes.
• Engage employees in decision-making when necessary.
• Collaborate with project management on the automation of processes.
• Create your change management plan based on organizational risk tolerance.

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1 ITIL Definition  (link resides outside ibm.com), Tech Target

2 Definition  (link resides outside ibm.com), Kotter Inc.

3 Kurt Lewins Change Management  (link resides outside ibm.com), Tech Target

4 7-S Framework  (link resides outside ibm.com), McKinsey, 2008

5 Methodology Overview  (link resides outside ibm.com), Prosci

20 Types of Change Management Methodologies to Transform your Organization

Change is a natural part of an organization’s growth and development. 

Every organization needs to adopt to new technology, process and business model in order to evolve and grow and stay relevant in its business. 

Then, how change can be successfully executed and organizations adapt to change ?

There are change management methodologies which are effective tool to help  organizations adapt and thrive in a constantly changing business environment

In this blog post, we discuss what are top 20 change management methodologies and why these are important and how these can be used in change process to ensure successful execution of change initiative. 

WHAT IS CHANGE MANAGEMENT?

Change management is a systematic and strategic approach to dealing with change and managing change at organizational level. 

Change management includes steps and process that lead change from its conceptualization to reaching its desired results or final outcome.  

Organizational change is driven either by external or internal factors. External factors include market economy, macro-economic situation, business eco-system, government laws and business regulation etc. Many a times, organizational internal factors drive change such as change in leadership, technological advancement, profitability, customer demand etc. 

Why are change management methodologies important?

Change management methodologies are important because they provide a framework and guiding principles for entire change management process. Without a proper direction and framework, it is hard to navigate through disruptive change. 

Change management methodologies provide a structured approach to identify need for change, develop a plan, implement that plan, track progress and measure its results. 

These methodologies help organizations to be more proactive and strategic in their approach to change, rather than reacting to change as it happens.

Change management methodologies are also important because they help change leaders to communicate more effectively about the change process. By using a common language and framework, change leaders can ensure that their team is fully involved in the change process and working towards the same goals. This ultimately helps to reduce anxiety, stress and conflictamong team and improve the chances of success for the change initiative.

20 Change Management Methodologies 

Here are top 15 change management methodologies that help organizations to transform their business.

1. Bridges Transition Model 

William Bridges developed a model which explains change by adopting three stages model of change management. It is often called as Bridges Transition Model .This model help organizations navigate the psychological aspects of change, including the ending of one phase, the neutral zone, and the beginning of a new phase.

• Ending Phase is about ending old ways of doing thing. It is not easy as it may cause lot of negative emotions. 
• Neutral Zone is about controlling negative emotions and learning about what will be the future. 
• New Beginning is about embracingchange and adopting new skills in order to fit into new realities. 

Change leaders and management need to understand the emotional perspective of employees who are going through change and help them to have successful transition from one stage to another. 

2. ADKAR Model 

ADKAR model is one of the most popular change management methodologies.  ADKAR stands for Awareness, Desire, Knowledge, Ability and Reinforcement.  The model focus on individual or employee who is affected by organizational change.  

It guides change leaders to first create understanding about change; the second action is to create willingness among employees to implement change; the next action is to give required knowledge about the change; the fourth action is to build skills of employees and the final action is to sustain a long lasting and impactful change.

3. Lewin’s Change Management Model

Lewin’s change management model is based on the concept that change involves three stages: unfreezing, changing, and refreezing . First stage is unfreezing which is about getting people prepared to start the journey of change. Second stage is change which talks about transition and what does it entail to experience the process of transition. Third and the last stage is freezing which is all about the stability and how change is institutionalized in the culture of an organization.

4. Burke Litwin Model of Change

This model model explains three levels of changes:  transformational, transactional changes and changes in performance in an organization which are derived by 12 factors or drivers of change. These factors are: external environment, mission andstrategy,leadership, organizational culture, structure, system, management practices,working climate, task and skills,individual values and needs, motivation level, individual and organizational performance. 

5. Leavitt’s Diamond Mode l

Leavitt developed this model which helps to understand four factors that are: structure, task, people and technology. This model is also known as Leavitt’s Diamond model and its basic concept is that if one variable of organizational change is changed it does affect other variables.

If structure gets changed then it will affect people, tasks and technology and if there are changes in human resource or employees then it will affect other factors which are structure, tasks and technology.

6. Kubler Ross Change Curve Model

Kubler Ross widely known as change curve model is based on 5 stages of grief and loss to explain emotional transitions an individual face while experiencing emotionally difficult situation.            

• The first stage is shock or denial when an employee does not accepts new reality; 
• The second stage of anger comes when employees reacts on what is happening; 
• The third stage is called bargaining when employee wants to delay change;
• The fourth stage is depression which he surrenders and becomes extremely sad with lowest energy and productivity;
• The last stage is of acceptance when employees embrace change and find solutions to adjust in the new situation.

This change management methodology helps organizations to understand emotional reaction of their employees while experiencing change and how organizations respond to these reactions and help employees cope with changing situation.

7. Kotter’s 8 Steps Model of Change Managemen t

Kotter’s 8 steps model  is also one of most effective change management methodologies to explain acceptability of change through adopting eight steps :

First step: create urgency for change. 

Second step: bring together like-minded employees to form coalition for change

Third step: create vision of change

Fourth step: communicate vision of change 

Fifth step: remove obstacles 

Sixth step: create short wins 

Seventh step: build on small changes 

Eight step: make change a part of organizational culture.

8. Iceberg Model of Change Management

Wilfried Kruger uses analogy of iceberg to explain process and dynamics of change management. This method mainly focuses on roadblocks or barriers of change and how these barriers can be removed to ensure change to take place smoothly without causing any problem.

Ice Berg Model of Change Management explains that managers usually narrowly define three factors of change and these are: cost, quality and time. These are issues which are related to organizational management. And these are the only tip of iceberg. These are only 10% of change happening in organization and 90% of change is below the iceberg. 

9. Nudge Theory of Change Management

As the Nudge theory is about indirectly influence individuals without taking freedom of choice. It discourages any change in behaviour of employees by giving them strict orders and directions.  Nudge Theory of Change is about giving choices and providing enabling environment and support that would lead to change in their behaviour which lead to long-lasting change. It is not an easy process and it takes time to influence their behaviour towards change. This process starts with analysing the current behaviour of employees and what are the desired changes in their behaviour and then development of supporting environment that influence their behaviour. 

10. McKinsey 7S model 

This change management methodology is developed by McKinsey which is a renowned management consulting firm. In this method, the 7S refers to the seven factors t hat start with the letter ‘S’ namely strategy, structure, system, shared values, skills, style and staff. These factors determine how is organization designed and how does its different parts of organization work together to implement change in that organization.

11. The Diffusion of Innovation

This model explains how new ideas and practices spread through an organization.  Diffusion of Innovation explains how an innovative idea or technology is spread and adopted and what are factors which influence this adaptation. Diffusion is the process by which an innovation is communicated through certain channels over time among the members of a social system. So, it has four elements: innovation, communication channels, time and social system.

12. Action Research

Action research is a method of inquiry that is used to identify and solve organizational problems. It involves identifying problem or issue that needs to be addressed. This is done by gathering data and information about the problem. The next step is acting calls for taking action to address problem and involve implementing change such as adopting new policy, process  or technology. The next step is observing that is all about collecting feedback from employees and stakeholder on adopted change. The last step is reflecting that is about analysing results and learning from the results to make improvements in change interventions.  

13. Capability Maturity Model

Capability Maturity Model (CMM) is a framework for evaluating an organization’s readiness for change and for guiding the implementation of new processes and practices. It is based on the concept that organizations go through five levels of maturity when it comes to managing change:

• Initial (Level 1): At this level, change management is ad hoc and reactive, with no formal processes in place.
• Repeatable (Level 2): At this level, change management processes are established and documented, but they are not consistently followed.
• Defined (Level 3): At this level, change management processes are standardized and consistently followed across the organization.
• Managed (Level 4): At this level, change management processes are actively monitored and measured for effectiveness.
• Optimizing (Level 5): At this level, change management processes are continuously improved through the use of data and analytics.

14. Three Horizons of Growth Model

Three Horizons of Growth Model is method used in change management to plan and manage change. The concept is thatorganizations can be divided into three horizons: the current state (Horizon 1), the near-term future (Horizon 2), and the long-term future (Horizon 3).

Horizon 1 represents the core business of the organization, and includes the products, services, and processes that are currently driving the majority of the organization’s revenue and profits. Horizon 2 represents emerging opportunities and challenges that are likely to impact the organization in the next 3-5 years. These may include new technologies, market trends, or changes in customer needs. Horizon 3 represents longer-term opportunities and challenges that are more uncertain and may take 5-10 years or more to materialize.

Using this method organizations can balance short-term and long-term priorities and identify or invest in opportunities that will drive future growth. 

15. Satir Change Model

This method is used to understand 05 stages of change that individuals and organizations go through. These five stages are:

• Status quo: This is the starting point, where organizations are comfortable and resistant to change.
• Chaos: This stage is characterized by confusion and uncertainty as organizations begin to let go of the old way of doing things and starts to find new possibilities and opportunities.
• Integration: This stage is marked by the beginning of new patterns and behaviors as organizations start to integrate the changes in their process. 
• Practicing: This stage is characterized by the refinement of new behaviors and process and development of new skills.
• Consolidation: In this final stage, the changes become fully integrated into organizations identity and way of functioning.

16. Competing Values Framework

The Competing Values Framework is used for understanding and managing organizational culture. It is based on the idea that different types of organizational cultures can be characterized by four values:

• Clan culture: This type of culture is characterized by a strong sense of community and collaboration. 
• Adhocracy culture: This type of culture is marked by a high degree of flexibility and adaptability. 
• Market culture: This type of culture is characterized by a focus on competition and performance.
• Hierarchy culture: This type of culture is marked by a strong emphasis on control and stability. 

17. The Force Field Analysis

 It is simple but practical methodology of change management.  Force Field Analysis is about identifying and analying different factors which are influencing a change initiative. There are multiple forces which are working in favour of change and against change. These forces are not physical but actually these are influences and circumstances that are driving or rejecting the change idea. 

If an organization maintains equilibrium by balancing both forces, then there is no change happened. Change happens only when equilibrium is disrupted. It means that an organization needs to over come the opposing forces by strengthening the driving forces.

18. Theory of Constraints

The Theory of Constraints (TOC) is one of effective change management methodologies that is based on the idea that organizations are limited by certain constraints that can prevent them from achieving their change goals. These constraints can be internal (e.g., processes, systems, policies) or external (e.g., markets, competition, regulations). There are five steps to identify and manage these constraints. 

• Identify the constraint: The first step is to identify the key constraint that is limiting the organization’s ability to achieve its change goals. 
• Exploit the constraint: The second step is to focus resources and efforts on maximizing the capacity of the constraint.
• Subordinate everything else to the constraint: The third step is to align all other processes and activities with the constraint, so that they do not interfere with its operation.
• Assess the constraint: The fourth step is to identify ways to improve or remove the constraint, such as through investment, training, or process improvement.
• If the constraint has been broken, go back to step one: The final step is to repeat the process, as new constraints may emerge as the organization evolves.

19. PDCA Cycle

The PDCA cycle is a valuable method for change management because it provides a structured approach for identifying problems or opportunities, developing and implementing plans to address them. The PDCA cycle consists of four steps:

• Plan: The first step is to identify the problem or opportunity that needs to be addressed, and to develop a plan for addressing it. This may involve gathering data and analyzing the current situation.
• Do: The second step is to implement the plan and take action to address the problem or opportunity.
• Check: The third step is to gather data and feedback to evaluate the results of the action taken.
• Act: The final step is to reflect on the results of the action taken, and to determine what changes should be made to the plan based on the feedback and data collected. This may involve making adjustments to the plan, or starting the cycle again with a new problem or opportunity.

20. Lean Change Management Model

This method is based on the principles of lean manufacturing and is designed to help organizations implement changes in a more agile and efficient way. It focuses on identifying and addressing the root causes of problems, and on continuously improving processes and practices. The model includes five steps: define the problem, develop a hypothesis, test the hypothesis, implement the solution, and reflect on the results. The Lean Change Management Model is particularly useful for organizations that are looking to adopt a more agile and responsive approach to change management.

Final Words

There are many different change management methodologies that organizations can use to guide their efforts to implement and manage change. These methodologies offer a range of approaches and frameworks for knowing their change, understanding its reasons and needs and navigating the complexities of change. Some, like Kotter’s 8-Step Change Model and Lewin’s Change Management Model, focus on the process of change itself, while others, like the ADKAR Model and the Change Curve, focus on the psychological aspects of change. Still others, like the McKinsey 7-S Model and the Three Horizons of Growth Model, take a more holistic view of organizational change. Selection of the right change management methodology will depend on the specific organizational needs and goals and on the nature and scope of the change being implemented.

About The Author

Tahir Abbas

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The Complete Guide to the Change Management Process

Change is a constant in the world of business and beyond. From adapting to new technologies to restructuring teams, understanding how to manage change is essential for success. This is where the change management process comes into play - it helps guide individuals and organizations through these changes, minimizing resistance, and achieving objectives efficiently. With this comprehensive guide to the change management process, you can learn how to navigate these transitions more effectively.

What is the Change Management Process?

Change management process steps, why is the change management process important, change management process models, who is responsible for change management process, how to use creately to successfully lead your change management process.

The change management process is a methodical approach for planning, implementing, and overseeing change within an organization. It is designed to help organizations and individuals manage transitions effectively.

It involves identifying the need for change, planning and analysis, stakeholder engagement, designing the change, implementing it, monitoring and evaluation, gathering feedback, and ultimately sustaining the change to become a part of the organization’s culture. This process helps organizations minimize disruption and resistance while optimizing the benefits of change.

Here’s a detailed breakdown of the change management process;

1. Identify the need for change

This is the starting point where you recognize that a change is necessary. It could be due to various reasons, such as market dynamics, new technologies, or internal issues. Identifying and understanding the reasons for change is crucial.

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2. Planning and analysis

Once the need for change is identified, you create a comprehensive plan. This plan outlines the change’s objectives, scope, and potential impact on the organization. It should also include a timeline, resource allocation, and risk assessment.

3. Stakeholder engagement

Engaging with stakeholders is an important aspect of change management. This includes communicating with employees, customers, suppliers, and other relevant parties. It’s essential to gain their support and address any concerns they may have.

4. Design the change

During this phase, you develop a clear vision of what the change will look like. This may involve defining new processes, technologies, organizational structures, or any other aspects of the change. The design phase sets the blueprint for the transition.

5. Implementation

With a solid plan and design in place, you begin to put the change process into action. This often involves training employees, updating systems or processes, and making any necessary adjustments to align with the new vision.

6. Monitoring and evaluation

Throughout the implementation, continuous monitoring and evaluation take place. You assess how well the change aligns with the initial objectives. This phase allows you to identify and address any issues or deviations from the plan.

7. Feedback and adaptation

Collecting feedback from stakeholders is a critical part of the process and can be done during a retrospective meeting . You should be open to feedback and use it to make necessary adjustments to improve the change process. Adaptation helps make sure that the change remains on the right track.

8. Sustain and institutionalize

Once the change is implemented successfully, it’s essential to make sure that it becomes a permanent part of the organization’s culture. This involves creating new norms, behaviors, and practices that support the change and prevent a return to the old ways.

Minimizing disruption : Change can be disruptive, and without a structured process, it can lead to chaos. Change management process helps mitigate this by providing a clear roadmap for the transition.

Reducing resistance : People often resist change due to fear of the unknown or concerns about their roles. Change management strategies address these concerns, making it easier for employees to embrace change.

Optimizing benefits : Change is usually carried out with specific objectives in mind, such as improving efficiency, increasing productivity, or responding to market demands. The change management process makes sure that these goals are met.

Improving communication : Proper change management plan makes sure that everyone affected by the change is well-informed, reducing misunderstandings and creating a sense of trust.

Improving project success rates : Many changes are part of larger projects. Change management process helps improve the success rate of these projects by addressing the human element, making sure that people are on board and ready to implement the required changes.

Maintaining employee morale : Change can be unsettling for employees, and if not handled properly, it can decrease morale and increase turnover. Through employee involvement and addressing their concerns, change management process aims to boost morale.

Change management process models are structured frameworks that offer a systematic and organized way to manage and implement change within an organization. They give a set of guidelines, steps, and best practices to help ensure that change initiatives are successful.

To learn more about these models in detail, refer to our post on change management tools .

• ADKAR model : ADKAR stands for Awareness, Desire, Knowledge, Ability, and Reinforcement. It focuses on individual change by addressing the key elements needed for a person to successfully transition through change.
• Kotter’s 8-step change model : This model outlines eight steps for implementing change effectively, from creating a sense of urgency to anchoring the change in the organization’s culture.
• Lewin’s change management model : This model consists of three stages: Unfreeze, Change, and Refreeze. It highlights the need to unfreeze the current state, implement the change, and then refreeze the new state as the norm.
• The McKinsey 7-S framework : This model focuses on seven key elements that need to align for change to be successful: Strategy, Structure, Systems, Shared Values, Style, Staff, and Skills.

In the change management process, several key stakeholders and roles play important parts in successfully planning and implementing change. These typically include:

Using an online visual collaboration platform like Creately can streamline communication, improve transparency, and boost teamwork throughout the change management process. It also helps make sure that all essential information is stored in a central location for easy access and reference.

Initiation and planning

Create a workspace dedicated to your change project in Creately. This workspace can be divided into different sections, each addressing various aspects of the change management process such as readiness for change, vision, objectives, stakeholder mapping, and communication planning. Invite all relevant stakeholders making sure everyone has access to it.

Collaborative ideation and design

Facilitate collaborative brainstorming sessions where team members can contribute ideas for addressing challenges and seizing opportunities. Make use of premade brainstorming templates or sticky notes to visualize, record and organize ideas.

Documentation and resource management

Store and manage all change management documents, templates, and resources within the same workspace. This includes change plans, communication materials, training resources, and risk assessment documents. You can add these as attachments inside the notes panel, links on shapes or as embeds in the workspace.

Task management and progress tracking

Use Kanban task boards and task cards to assign, track, and manage tasks related to the change process. Use these boards to assign ownership, set deadlines, and update task statuses.

Collaborative meetings and workshops

Schedule and host virtual meetings and workshops using Creately’s integration with Microsoft Teams Creately’s integration with Microsoft Teams . Create and share agendas, relevant documents, and visual aids using Creately.

Remember, change is not just a challenge; it’s an opportunity. By following the steps outlined in this guide and leveraging the capabilities of modern digital tools, organizations can use change as a driver for growth, fostering innovation, and a resilient culture.

Join over thousands of organizations that use Creately to brainstorm, plan, analyze, and execute their projects successfully.

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Amanda Athuraliya is the communication specialist/content writer at Creately, online diagramming and collaboration tool. She is an avid reader, a budding writer and a passionate researcher who loves to write about all kinds of topics.

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Home » Change Management » The 3 fundamental change management methodologies you need to know

The 3 fundamental change management methodologies you need to know

Change management methodologies provide a framework to efficiently implement organizational change . Experienced change practitioners produce change management methodologies based on common patterns in change projects. 

A change management methodology helps you deliver several bottom-line benefits of change projects. That could mean better project outcomes, decreased employee resistance, and shortened project timelines. So there are many good reasons for understanding these models before starting a change project. 

This article will introduce the major components of change management models and examine three particular models in detail. We will: 

• Carefully define the meaning of a change management methodologies; 
• Introduce the ProSci, Kotter, and ACMP models; 
• Suggest some key questions for how to choose your methodology. 

Along the way, we will signpost further research and reading that can help you achieve a complete understanding. 

What Are Change Management Methodologies?

Change management is the discipline dedicated to designing, managing, and leading organizational change. A change management methodology helps leaders prepare, implement, and evaluate a change’s impact on a company’s performance. The methodology provides a practical framework, or roadmap, which outlines a set of actions to follow.

The goals of these frameworks are often very similar:

• Define a vision, strategy, and plan
• Develop a communication strategy
• Allocate resources and create change teams
• Ensure that employees have the necessary knowledge and training
• Implement, manage, and lead the change program
• Reinforce change to ensure that the changes remain permanent

However, the biggest challenges in a change project will differ for every company. The challenges of change can depend on organizational structure; the industry; geographic location; culture; and much more. That’s why many change management methodologies have been created. Fortunately, this choice of methods based on change management research helps change leaders decide the best approach for their company. 

Some change management models are based on strong leadership, others prioritize consensus among organizational staff, and some have special relevance for technologies. 

• Kotter’s 8-Step Process for Leading Change 
• Lewin’s Change Management Model   
• The Lippit-Knoster model for complex change   
• Bridges’ Transition Model
• McKinsey 7 Ss Model for organizational transformation 
• ITIL change management methods 
• Satir Change Model
• Agile change management  

We won’t discuss these change management models in this article – after all, we’ve got special posts on many of them (just click the links in the list!). But to get some insight into how different models shape up, we will compare three prominent methods in the next section. 

A Comparison of 3 Change Management Methodologies

This section will dive deeper into the important change management models. From all the valuable models on our list, we will look at: 

• Prosci’s model for the “human element” of change; 
• Kotter’s 8-step model; 
• ACMP’s Standard for change management. 

You might find that one of these models is perfect for your current organizational challenges, But even if they don’t fit, you can learn a great deal by studying them. A good change practitioner will always adapt their models to achieve successful change. 

Prosci’s Methodology

Prosci’s change method takes two approaches: individual change and organizational change.

The ADKAR framework, their roadmap for implementing change at the individual level, consists of five stages:

• Create awareness of the need for change
• Cultivate a desire to support the change
• Provide teams with the knowledge of how to change
• Ensure employees can demonstrate the ability to implement required skills and behaviors
• Reinforce the change to ensure that it sticks

This model is used in conjunction with a three-phase process for organizational change:

• Prepare for change by defining the change management strategy, preparing the change management team, and developing the sponsorship model
• Manage change by developing change management plans, then taking action and implementing those plans
• Reinforce change by collecting and analyzing feedback, identifying gaps, managing resistance, implementing corrective actions, and celebrating successes.

For Prosci, linking individual and organizational change management distinguishes their method from other methodologies.

Kotter’s 8-Step Model

Dr. John Kotter’s 8-step model for change presents a straightforward process that managers and business leaders can follow when pursuing a new change initiative.

These steps include:

• Create a sense of urgency
• Build a guiding coalition
• Form a strategic vision and initiatives
• Enlist a volunteer army
• Enable action by removing barriers
• Generate short-term wins
• Sustain acceleration
• Institute change

This model aligns with Prosci’s ADKAR model in many respects since it emphasizes the need for guiding and engaging employees.

However, it also includes elements that focus on the organizational side of change, such as forming a strategy.

ACMP’s Standard for Change Management

ACMP’s Standard for Change Management is a comprehensive and detailed methodology developed by the Association of Change Management Professionals.

Their process includes five steps:

• Evaluate change impact and organizational readiness
• Formulate the change management strategy
• Develop the change management plan
• Execute the change management plan
• Complete the change management effort

These five steps, in turn, consist of many other smaller steps and activities that overlap with many of the activities covered in the two methods outlined above.

Professionals wishing to learn and apply this system can obtain training through qualified providers or certification from the ACMP directly.

Choosing the Right Change Management Methodology

Selecting the right change management methodology is a pivotal decision with profound implications for an organization. The methods chosen shape how successfully and smoothly the change initiative is embraced by stakeholders. It directly influences whether goals are met or missed, resources are optimally utilized or wasted, and resistance is minimized or amplified. 

To help you in your journey for a change methodology, here’s a long list of key questions you can explore: 

• What is the nature of the change?
• What are the organizational goals and objectives?
• What is the corporate culture?
• What is the level of stakeholder involvement?
• What is the timeline for implementation?
• What resources are available?
• What is the level of risk tolerance?
• What communication and engagement strategies are needed?
• Is agile or iterative implementation desired?
• Is individual behavior change important?
• What does success look like?
• Is external expertise required?

More deeply, you will need to think about who will manage the change, what those managers’ preferences are, and how much experience they have in change management. Likewise, you’ll need to consider the preferences of staff and leaders and the alignment between a change methodology and the organization’s culture. 

Although the popular change models have a track record of success, positive outcomes will often depend on the capabilities of a change leader. For instance, a change practitioner who has experience in one method will be better prepared to use that method in a new environment. They can understand the strengths of the model (and its weaknesses) and better prepare for organizational success. 

At the start of their change journey, companies should allow some time to dig deeper into the various methodologies. Building an enterprise change management function is no mean feat – so listen to the guidance of people who’ve gone before. 

Change Management Methodologies: What Next?  

To wrap up this article, let’s finish with a simple thought. 

A change management method is a “must-have” for organizational change. Organizations use a comprehensive change management process – because they know it is a very useful and effective way to get change right. It helps you to avoid poor planning and to get a positive response from stakeholders.  

Of course, it’s hard to make decisions about the right method. There are many examples from the history of change management (as we have seen). 

Remember that change management, like any organizational discipline, is always developing. For example, even though McKinsey has a very popular change management model (the 7 Ss), they continually show that successful transformations must adapt to the present moment. 

To learn more, keep up with the latest research, read our change management articles , and think carefully about your strategic vision.

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Organizational Change Management: What It Is & Why It’s Important

• 21 Jan 2020

Virtually every organization will, at some point, undergo a transition or change in order to remain viable and scale. Whether onboarding new employees, growing a department, or merging with another company, these changes can have a significant impact on the trajectory of your business.

Unfortunately, organizational change isn’t always easy to adapt to and can be intimidating for all team members who find themselves impacted by it.

As a manager tasked with overseeing organizational change or guiding your employees through it, it’s important to know what the process looks like and what to expect. Change, although challenging, can be a major opportunity for growth and career advancement, so long as you know how to approach it.

Here’s a primer on what organizational change management is and some tips for navigating it.

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What is Organizational Change Management?

Organizational change refers to the actions in which a company or business alters a major component of its organization, such as its culture, the underlying technologies or infrastructure it uses to operate, or its internal processes. Organizational change management is the process of guiding organizational change to a successful resolution, and it typically includes three major phases: preparation, implementation, and follow-through.

What Causes Organizational Change?

Many factors make organizational change necessary. Some of the most common faced by managers include:

• New leadership at the helm of the company or within its departments
• Shifts in the organizational team structure
• The implementation of new technology
• The adoption of new business models

To ensure a smooth transition, it’s important to have a set organizational change management process that can be applied across various types of change.

Types of Organizational Change

Adaptive changes are small, incremental changes organizations adopt to address needs that evolve over time. Typically, these changes are minor modifications and adjustments that managers fine-tune and implement to execute upon business strategies. Throughout the process, leadership may add, subtract, or refine processes.

One example of an adaptive change is an organization that upgrades their computer operating systems from Windows 8 to Windows 10.

Transformational changes have a larger scale and scope than adaptive changes. They can often involve a simultaneous shift in mission and strategy, company or team structure, people and organizational performance, or business processes. Because of their scale, these changes often take a substantial amount of time and energy to enact. Though it's not always the case, transformational changes are often pursued in response to external forces, such as the emergence of a disruptive new competitor or issues impacting a company’s supply chain.

An example of a transformational change is the adoption of a customer relationship management software (CRM), which all departments are expected to learn and employ.

Many changes will fall somewhere between adaptive and transformational on the spectrum. For this reason, managers need to understand that the change process must be tailored to the unique challenges and demands of each situation.

Why Is Organizational Change Management Important?

Organizational change is necessary for companies to succeed and grow. Change management drives the successful adoption and usage of change within the business. It allows employees to understand and commit to the shift and work effectively during it.

Without effective organizational change management, company transitions can be unpredictable and expensive in terms of both time and resources. They can also result in lower employee morale and skill development.

A company’s reaction and adaptation to change is also a critical consideration for key stakeholders like investors, suppliers, and prospective employees when deciding whether to work with or for a company. As a result, a lack of effective change management can lead to an organization’s failure.

A Manager’s Role in Organizational Change

Within an organization, every employee has a different role in assisting with change. While many staff members may complete heavily detailed work, senior-level executives with longer tenure might have different goals. Even within management, leaders and managers perform different tasks.

Leaders, for example, have to be courageous by taking on risks. They need to look at the big picture and articulate high-level change to the company, explain why it’s occurring, and motivate people to support the transition. To be successful as a leader , you must be insightful and know who to put in charge of carrying out change processes.

Managers are more concentrated on making business transitions successful. They focus on implementing change by determining the discrete steps that need to happen and their sequence. Managers are also typically responsible for allocating resources, such as personnel, and determining how success is measured. Ideally, leaders will also be managers , but it’s the primary responsibility of a manager to know how to design, direct, and shape change processes.

To achieve this, you must have a wide array of management skills , such as:

• Effective communication , including actively listening to your team and colleagues
• A highly developed level of emotional intelligence
• Strong organizational skills
• Attention to detail
• Problem-solving and decision-making skills
• Delegating without micromanaging

Preparing for Organizational Change

To prepare for organizational change, it’s essential to first define the organizational change, understand why it’s critical, and garner support from your colleagues.

Then, create a roadmap that clearly articulates and measures success and explains how the business—and its employees, customers, and constituencies—will be affected.

Ensure the process plan aligns with business goals and outlines the implementation and sustainability of the organizational change. Note what challenges may arise and be flexible enough to adjust accordingly. Be sure to celebrate small victories along the way.

Change management doesn’t stop once you’ve successfully executed an organizational transition. Both during and after the process, you need to continuously assess outcomes, track performance to goals, train employees on new methodologies and business practices, and readjust goals as necessary to increase the likelihood of success.

Developing the Skills You Need to Manage Organizational Change

Many managers experience organizational change throughout their careers. By learning how to preempt and address the challenges associated with change, you can ensure you’re equipped with the skills and knowledge needed to manage it.

If you’re looking for opportunities to improve your organizational change management abilities, enrolling in an online management course, like Management Essentials , is one option that can provide you with real-world skills, teach you common business strategies, and prepare you to handle any transitional challenge that comes your way.

Do you want to become a more effective leader and manager? Download our free leadership and management e-book to find out how. Also, explore our online leadership and management courses to learn how you can take charge of your professional development and accelerate your career.

This post was updated on January 3, 2023. It was originally published on January 21, 2020.

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What is change management? 5-step process and guide

It’s human nature to seek out comfort. Nobody wants to crawl out of a warm bed to get up for the day — especially if it’s cold outside of the cozy covers. Change is hard! That’s why it’s also human nature to resist it.

However, change is happening all the time — from technology, to regulations, to the internal processes that define how an organization operates. The need for change can seem obvious and sometimes even appealing, but that doesn’t make it easy.

The frequency of change is only going to increase as the technology and business landscapes evolve. That’s why it’s common and advisable for organizations to implement some kind of change management process.

What is change management?

Change management is the process of preparing for and executing a smooth transition or transformation at the organizational level.

When teams or businesses implement sweeping changes to processes, strategies, tooling, etc., they use a change management process to ensure adoption and measure the effects of those changes across the organization.

What does successful change management look like?

Given that change is so important, you might be surprised to learn that most change initiatives don’t work. According to Gartner , approximately 50 percent of change processes are unsuccessful.

A 5-step process for change management

Harvard Business Review published a great breakdown of five critical steps to execute a successful change management process. I encourage you to read it in full, but I’ll summarize the main points below:

• Prepare the organization for change
• Craft a vision and plan for change
• Implement the change
• Embed changes within company culture and policies
• Review progress and analyze results

1. Prepare the organization for change

To prepare for change, you need to look at both cultural and logistical elements. Remember, organizations are people at their core; making people aware of the need for change and gaining that initial buy-in is critical.

2. Craft a vision and plan for change

You know where you are today; this stage is about how you get to where you want to be.

Setting out a vision helps people see what the future may look like. The plan should include:

• Strategic goals — Why is this change happening in the first place?
• Key performance indicators (KPIs) — How will you measure success ?
• Project team and stakeholders — Who is responsible for each task? What needs to be signed off on and when? What governance is needed?
• Project scope — What is part of the change and what will fall outside the remit of this project?

3. Implement the change

This involves following the plan and taking the steps that will take you from where you are now to where you want to be.

Sounds easy, but no plan ever accounts for everything. You will need to adapt as you learn along the way.

Remember, communication is crucial to keep people aware of how the change is progressing. Also, as much as possible, empower your people to take charge of the change they are responsible for.

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4. Embed changes within company culture and policies

Again, HBS advocates for a holistic approach. Think about the behaviors that make up cultures as well as processes and policies.

It is during this transitional stage a lot of hard work can be undone if people slip back to what is comfortable for them.

5. Review progress and analyze results

Change is rarely ever undertaken just to make a change. A goal is set out to be achieved and agreed upon as part of the project planning.

Once the plan is complete, review whether the goal was achieved and any lessons learned through the process.

Promote individual change using the ADKAR model

Change management professionals use the ADKAR model to understand the components necessary to make changes successful.

Jeff Hiatt developed the ADKAR model after studying the change patterns of more than 700 organizations. ADKAR is an acronym that stands for awareness, desire, knowledge, ability, and reinforcement:

• Awareness — You need to build up an appreciation of the need to change within your organization so people know that a change needs to take place
• Desire — Even if people are aware of the need for change, they might not want to change. It’s an important distinction; without that desire people are unlikely to buy into the steps required to make the change successful
• Knowledge — Change often means embracing alternative ways of doing things, but do you have the requisite knowledge to execute these new approaches? This is often a source of stress for employees and a high barrier to change
• Ability — You also need to consider tools and equipment; making sweeping changes to how employees use these tools (or which tools they can use) can be jarring if not approached tactfully
• Reinforcement — This part is the responsibility of leaders. Do they set a good example and carry out the behaviors needed to make a change stick?

If you neglect even just one of the components described above, the change will not stick. For example, without reinforcement from leaders, people will inevitably regress back to what was comfortable before the change went into effect.

How to implement the ADKAR model

So, how can you use the ADKAR model as part of a change management process? For one, you can link it to the activities in your plan. Have you included training for the team? Do you need to budget for new equipment? Does your communication plan include senior leaders? If so, what do you expect of them?

You can also use this model as a self-assessment tool. I have found it particularly useful for gathering the team’s perspective on the change. After one such session, we realized our training plan was nowhere near good enough. So, we threw it out and worked with the team to design a new change management that helped them get comfortable with the system.

Support your people using the Change Curve

Organizations are collections of people and, at the end of the day, it’s people who will experience any change you implement. Your ability to support them is one of the most critical success factors when managing an organizational change.

The Change Curve is based on a model originally developed by Elisabeth Kübler-Ross in the 1960s to explain the grieving process. Today, it is widely used by change management practitioners to explain the process people go through when a change happens.

When used for change management purposes, the Change Curve features recommended steps and approaches for leaders to take at each stage. There are lots of different versions of the Change Curve, but here’s a typical example of how the model applies in practice:

As we go through the Change Curve, the type of support required evolves.

Getting through to the acceptance stage is critical for successful change. If people are not supported, they’re liable to get stuck at a certain stage and never advance.

Consider a change that has happened in your organization recently. Where did your people fall on this Change Curve?

Change: A necessary evil

Change is hard. As humans, comfort is not just the default, but a position we actively seek.

Cold? Put a jumper on. Hungry? Eat some food.

However, change is constant and required to stay competitive and compliant.

When making a change in your organization, make sure you have a plan, ensure you have all the ingredients that make up successful change (e.g., as per the ADKAR model), and do everything in your power to support your people.

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3 Replies to "What is change management? 5-step process and guide"

I like how this post emphasizes the importance of embracing change, especially in today’s fast-evolving business environment. Change management is crucial for organizations to navigate these shifts effectively and stay ahead in the ever-changing landscape.

Change management is the structured approach to transition an organization or team from the current state to a desired future state.Nice knowledge-gaining blog. This post is the best on this valuable topic.

The content of your blog is excellent, and you cover each topic comprehensively, but I have a question about how small businesses can adapt to these changes and whether it will be beneficial to them. If you could reply, I would greatly appreciate it.

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What is change management?

Levels of change management, considering the human side of change management, the six principles of change management, how to implement a change management plan, change management: the challenges, overcoming the change management challenge.

They say change is the only constant. We'd argue resistance to change is another. And that has never been more true than in today’s rapidly-changing business environment. Technology and globalization are driving change like never before. Organizations know they must adapt to survive. But transitions are delicate processes. They must take into account the human factor while meeting the organization’s goals. Too many change management plans have covered every detail. Except for those pesky humans. To succeed, you need a solid change management plan and a team of committed people to implement it. Not sure what change management is? Let’s take a deep dive into change management and the concept.

Change management is a set of strategies, processes, and procedures companies use to manage organizational changes involving people. These processes help the transition go smoothly.

Why implement change management?

Changing your processes, operations, or tools requires support from management. You will also need buy-in from your employees.

Both  groups tend to be resistant to change  for different reasons.

Senior executives are often hard to convince. They don’t want to authorize changes that may be unpopular with employees.

They also might not see the value of the proposed change. Or perhaps they have a different opinion about the kind of changes needed.  What often goes unsaid is that large changes imply changes in budgets, resources, and influence. Change changes.

Employees are often resistant to change because they fear what change might bring. People fear increased workload, obsolete skill sets, vague expectations, or worse — getting fired.

That’s why change management puts the human factor at the center of the proposed changes.

An effective change management process guides the organization and all the people involved. It helps them get out of the current state, through the transition phase, and into the future state.

The 4 common models of change management

Thankfully, change management isn’t a new concept. There are established frameworks to organize, structure, and communicate change. While many different models of change management exist, some are more common than others. Let’s take a look at four tried-and-true models of change management:

1. Lewin’s change management model

Psychologist Kurt Lewin developed this change model in 1947 . It is one of the earliest change management theories.

Lewin’s model highlighted the need to go through a transition period to adapt to organizational change. 

In doing so, he defined change management as the process that manages that transition.

Lewin describes three stages of change management:

• Unfreezing old behaviors and ways of working
• Teaching new ones
• Freezing the new behaviors and ways of working

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2. Bridges’ transition model

This model,  developed by William Bridges , puts people’s emotions at the center of the change management process.

Like Lewin, Bridges identifies three stages of change management. Each stage is linked to different emotions. 

The three stages described by Bridges are:

• Neutral zone
• New beginnings

3. Prosci’s ADKAR model

Prosci’s change model goes by the acronym ADKAR . It stands for:

A: Awareness of the need for change

D: Desire to support change

K: Knowledge of how to change successfully

A: Ability to adopt the new behaviors or skills

R: Reinforcement of the change (similar to Lewin’s concept of “freezing”).

Like Lewin and Bridges, Prosci also identified three stages of change.

They are: 

• Preparing for change
• Managing change
• Reinforcing change

4. Kotter’s 8-step change model

Kotter’s eight-step change model is a top-down approach. 

This is different from Lewin, Bridges, and Prosci. They take a bottom-up approach to change management.

The focus of Kotter’s model is to keep up the momentum of the change process and prevent the project from stalling.

Kotter’s eight-step process for managing change is :

• Create a sense of urgency
• Build a guiding coalition
• Form a strategic vision and initiatives
• Enlist a volunteer army
• Enable action by removing barriers
• Generate short-term wins
• Sustain acceleration
• Institute change

Change management takes place at three levels: individual, organizational, and enterprise.

Let’s take a look at how it works at each level.

1. Individual change management

At the individual level, employees must understand the change process and their role in it.

To support their team, an effective change manager should prioritize the following tasks:

• Give clear instructions when assigning new tasks
• Teach employees new behaviors
• Motivate the team to implement the changes

Psychology and coaching principles can help people overcome their resistance to change . 

Often, just feeling supported is enough to help people adapt to the transition.

2. Organizational change management

Organizational change management is the process of implementing the proposed solutions and strategies.

Change at the organizational level requires a documented change management process. This document provides support and guidance for those affected by the proposed changes.

Identify the groups of people who will be involved in the change and define the actions they must take. 

Then create implementation plans for each level of the organization. These plans will help your employees implement the change.

3. Enterprise change management

Enterprise-level change occurs once the change management process is complete.

At this stage, the changes are embedded into the company. They should also be at the heart of the following areas:

• Company processes
• Company procedures
• Company structures
• Company projects
• Leadership competencies
• Roles and responsibilities

The objective of enterprise-level change management is to create an agile and flexible organization, regardless of size.

The change management program should leave your company better able to adapt to market changes and new technology. 

Change management today

In the past, most companies had one goal: to steadily increase their market share and profits by maintaining the status quo. Change management, therefore, meant making small internal changes. The aim was to maintain balance. 

In today’s globalized market, however, the business landscape has changed radically. This change has the following drivers:

• The opening of new commercial borders
• Labor mobility
• Global competition
• Instant communication
• Technological advances

21st-century companies need to be flexible and embrace a culture of change. This will help them stay relevant and profitable in an ever-changing market.

What does this mean for change management? For starters, organizational change management is more complex than it used to be. The changes are happening more rapidly and more often.

It might have made sense to create elaborate change and communication plans when the change was from one fixed system to another, on a scale that would only happen once in a decade. 

Companies today will face changes on both massive and more minor scales, more frequently. That requires new approaches to managing change in the organization.

What will change management look like in the future?

Change managers must devise effective strategies while taking into account the human element. This is essential for the change to be effective.

According to Prosci,  the future of change management has three key elements .

1. Collaboration with other disciplines

In particular, change management will integrate more with project management. Collaboration between project managers and change managers will increase.

Change management will continue to incorporate new technology and research. This includes everything from social media to the latest discoveries in neuroscience.

2. Greater focus on building organizational change management abilities

Change requires agents at all levels. Companies will reinforce their internal capacity for change management. 

3. Ongoing development of change management professionals

Change management certification programs are growing in demand, although the jury is out on whether these certifications can achieve significantly better results.

People are at the center of any major organizational change. Every decision affects them, and you need their buy-in for your change management plan to succeed.

Keep the following principles in mind to ensure your team remains engaged and supported throughout changes.

Lean into company values: Align your proposed change management program with  your organization’s culture , values, and behavior. Do this by holding regular meetings with line managers and their teams. 

Over-communicate: Communicate clearly and frequently with your teams. Explain the reasons behind the changes and give regular progress updates.

Encourage feedback and collaboration: Allow your team to participate as much as possible in the planning process. This will help align your decisions with the company culture.

In 2020, the  risk of change fatigue among employees doubled  following the COVID-19 outbreak.

At a time when organizations need to be more adaptable than ever, employees have lost their capacity to absorb change.

For this reason, change management processes must be more effective than ever.

These six principles of change can help minimize the impact on your team members:

1. Understand change 

The first step in successfully implementing change is for everyone to understand why it’s necessary and its benefits.

Executives and leaders must commit to the change process and understand its advantages. Understanding the change will help you explain its benefits to your employees. But to overcome the unarticulated, and even irrational, fear of change, you have to do more than explain its benefits.

The most successful change occurs when management and employees feel the need for change, see a compelling opportunity, and have trust and confidence in leadership. 

You must also help them understand the negative consequences of not implementing the change.

To fully understand the change process, it is necessary for everyone to know:

• The objectives and reasons for the change
• The benefits for the organization
• The impact on staff and their work
• Their role in making the change effective

2. Plan change 

To help ensure change happens smoothly, you should  develop a formal written plan . It will serve as a roadmap for your change process. It will also align executives and working groups on the goals of the project. Don't get so lost in the details that you lose sight of the compelling vision. Understanding milestones is critical. So, too, is realism about how much of the detail will shift and get new dates and details as the change process begins.

To create an effective change plan for your organization, you should:

• Get consensus and support from executive-level sponsors
• Plan how to generate support and commitment from your employees
• Identify internal and external sources of support, as they will help develop the strategy and implement the change process
• Measure the impact the change will have on vendors, clients, and human resources, and include potential adverse outcomes

Your change plan should include:

• A comparison of the current reality and the future vision after the change
• Clear articulation of the benefits and reasons behind the change
• Evidence that the organization can meet the stated objectives
• Details of the decisions and changes to be made at each level

3. Implement change

Once you have your change plan, you can start implementing change.

Appoint committed change agents at every level of the company to help you achieve the project objectives.

Train these employees so they can answer questions and guide their teammates through the transition. Managers should act as role models and coaches.

4. Communicate change 

Effective communication is essential  for the success of the change management process. Yet change managers often focus their efforts on creating detailed plans. In doing so, they neglect communication with their teams. 

As a change leader, it’s essential to provide regular updates to all stakeholders. These should be clear and easy to understand. 

One way to improve communication is through bilateral meetings. These are also an opportunity for leaders to receive feedback from their teams.

During these meetings, remain calm and respectful when discussing the change process. This will help prevent strong emotional reactions from your employees.

But too often even the best-detailed communication plans fail to open a channel of communication, which is so necessary to understand resistance and address fear.

Communicate the benefits arising from early wins. Let the early adopters go first and then make their stories so compelling everyone else will want to jump on board, too.

5. Encourage ownership

For the change process to succeed, leaders at all levels must have a sense of ownership.

When people are invested in a project, they see it as their responsibility and are motivated to make it happen.

One of the best ways to encourage ownership is to involve leaders in the change process in their areas of influence.

Rather than managing them, take a coaching approach. Allow them to intervene in the process and look for solutions to problems that may arise in their team’s day-to-day work.

Involving leaders in the process and keeping them informed will also reduce their resistance to change. This is important when making decisions that will affect the implementation of the change process.

You can also incentivize ownership by offering rewards to your employees. Reward leaders who take on new responsibilities and make decisions that help achieve the objectives.

6. Assess the cultural landscape 

A successful change process requires commitment at every level of the organization. 

For this reason, it’s essential to take into account the cultural background of your employees. Knowing your colleagues’ beliefs, behaviors, and perceptions can help prevent possible problems. 

It also shows your employees that you’re trustworthy and committed to making changes that benefit people at all levels of the company.

Additionally, it will help you assess whether the organization is prepared for the proposed changes.

Follow these tips for successful implementation:

• Support your employees as they go through the behavior change process
• Make sure everyone understands what will happen and how it will affect their work
• Monitor progress and carry out regular assessments
• Look for gaps in knowledge and skills and address them with training
• Identify the key stakeholders and define their level of commitment and participation in the change

The five most important skills for change managers

The good news is there’s no one-size-fits-all when it comes to change management leadership. Any kind of leader can learn the skills required to manage change effectively.

These are the top five skills needed for the job:

1. Emotional intelligence

Employee resistance is common during organizational transformation processes.

In general, people are resistant to change because of one primary driving emotion: fear.

This may be fear of the unknown, fear of losing their job, or fear of their role changing or increased responsibilities.

Fear makes people act in irrational ways and  is the root of a whole host of other emotions .

2. Clear communication

Excellent communication skills are a requirement for any leader. During a change management transition, communication must be clear and detailed. 

When managing a change process, you must clearly communicate the reasons behind the change and the procedures to follow. 

This will improve the chances of your change management strategy being successful.

3. Transparency

Going through a change initiative can be a sensitive process. This is especially true when it involves firing people.

However, it’s essential to be as transparent as possible with your employees. This will  build trust and help ease their fears .

Have an open-door policy so that colleagues can come to you privately with their concerns.

4. Coaching

A change manager should have the skills to coach their teammates through the transition process.

Leaders can train middle management in coaching techniques. This builds a coaching culture throughout the organization.

Coaching increases resilience , which will help employees navigate the transition period. Successful change management  requires leaders to have a high level of personal resilience .

Resilience helps you overcome the challenges of change implementation and achieve results.

5. Strategic thinking and attention to detail

Change management requires you to see the big-picture vision. At the same time, you need to stay focused on the day-to-day details as you move through the transition.

Change management is challenging by nature. To help you prepare, we’ve identified four of the most common change management challenges.

Change managers can mitigate the effects of these challenges using the solutions below.

1. Picking the right team

Creating a team of reliable change agents who can successfully implement the change program is a challenge.

You need your best people involved in the project, but they already have their work to do.

Change managers should look for people willing to go the extra mile to ensure positive results. To identify those people, have conversations with colleagues and line managers. 

Don’t just accept anyone who volunteers. Instead, find out from their coworkers what they’re really like. This will help make sure you pick the best people for the job.

2. Boosting commitment

Your change initiative needs commitment from both senior management and the employees who will have to deal with the changes.

You can overcome many objections by having regular conversations with stakeholders at all levels.

Be transparent and honest in your communication. This will help maintain support and commitment to the change project.

3. Balancing efforts

One of the biggest reasons your employees are resistant to change is that they are busy. 

They’re worried that the change process will mean more work for them. And often, they’re right.

The change management project team should calculate how much the change will increase each employee’s workload.

If the increase is more than 10% for any individual, look for ways to redistribute their tasks. 

This will prevent the changes from affecting some people more than others. It will also reduce the risk of overwhelm,  burnout , and change fatigue.

4. Managing the duration of the change program

People often think that a change program should be short to succeed.

They believe long, drawn-out transition processes gradually lose support and commitment over time.

But according to research by Harvard Business Review, that’s not true. In fact,  longer projects that are regularly reviewed are more likely to succeed than shorter projects .

This means the time between reviews is more critical for success than the overall duration.

A change management project should have clearly defined objectives, roles, and responsibilities.

Keep track of progress by conducting assessments every six to eight weeks. This will help identify gaps, challenges, and new risks.

Organizations that embrace change management have an advantage over those that don’t. 

They are more likely to stay relevant and profitable. This is why it’s worth facing the challenges of change management.

Apply the principles and tips set out in this article to overcome resistance and implement lasting change.

If you need extra support guiding your company through the change process,  discover how BetterUp’s expert coaches can help you .

Maggie Wooll, MBA

Maggie Wooll is a researcher, author, and speaker focused on the evolving future of work. Formerly the lead researcher at the Deloitte Center for the Edge, she holds a Bachelor of Science in Education from Princeton University and an MBA from the University of Virginia Darden School of Business. Maggie is passionate about creating better work and greater opportunities for all.

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What Is Change Management? Process & Models Explained

One thing is certain: change is going to happen in your organization or project. To best plan and respond to change, first, a clear definition of change management must be understood.

What Is Change Management?

The term change management refers to the actions, tools and models implemented to manage different types of change either at the project or organizational level. There are several organizational change management strategies that can be applied to manage work, resources, business processes and budget allocations as well as different types of organizational changes.

At the project level, you’ll need to set up a change management framework that guarantees that all changes to the project plan are properly approved, implemented and tracked so that the project timeline, budget or resources are not affected by any sudden changes made to the initial scope, schedule or budget baseline.

ProjectManager helps you make a change management plan and track it in real time, whether you’re managing project changes or organizational changes. Set up the plan with our robust Gantt charts, which populate the plan on a visual timeline so you can see it all in one place. Add resources, tasks, durations, milestones and task dependencies. Get started with ProjectManager today for free.

Change Management Models

Using change management models helps guide teams through necessary transitions at a project or organizational level. It can be difficult to adapt to new processes, but when you create a change management plan , you can obtain benefits for your organization. These change management models can help plan and manage organizational change.

Lewin’s Change Management Model

Kurt Lewin, a German-American psychologist, developed a change management model that breaks down change based on three phases: unfreeze, change and refreeze. The first phase prepares you for the change, then it’s implemented and, finally, that change is solidified.

McKinsey’s 7-S Change Management model

A more involved model than Lewin’s, this involves seven elements. They are the seven S’s, which are strategy, structure, systems, shared values, style, staff and skill. Unlike Lewin’s there is no specific order. They are used to address how each impacts the other in order to identify weaknesses.

Kotter’s Change Management Model

Dr. John P. Kotter is a professor of leadership, emeritus, at the Harvard Business School. He is known as the inventor of an eight-step process for leading change that has become instrumental in change management strategy.

• Create urgency
• Form a powerful coalition
• Create a vision for the change
• Communicate the vision
• Remove obstacles
• Create short-term wins
• Build on the change
• Anchor the change

This change management theory is an expansion on what is the bedrock of change management. Change management stands on four pillars. They are the determination that there’s a need for change, preparing and planning for that change, implementing that change and, lastly, sustaining the change.

ADKAR Change Management Model

This bottom-up method is focused on the people behind the change. ADKAR is an acronym that stands for awareness, desire, knowledge, ability and reinforcement. These are not in any order, but address the need to change, participate and support the change, know how to make the change, have the skills and behavior necessary for the change and then sustain it.

Bridges Transition Model

With this model, you’re focusing on the emotional reactions to change as it is implemented. Rather than dealing with the change itself, this model looks at how the people respond to ending, losing or letting go of something, the neutral point after the change is done and then opening up to a new beginning.

Kübler-Ross Change Management Framework

Based on the five stages of grief, this method acknowledges the emotional reaction people have to change. Just as the grieving process has five stages, so does the change process. These are denial, anger, bargaining, depression and acceptance.

Satir Change Management Model

This model is about measuring the emotional state of employees by tracking performance through these five stages of change: late status quo, resistance, chaos, integration and new status quo. Therefore, this model is about preparing and accepting change, not figuring out what needs change.

PDCA Change Management Model

Also called the Deming cycle, this model, PDCA stands for plan, do, check and act. These four phases help with process improvement by identifying the issue, making changes to address it, monitoring and taking action.

Nudge Theory

As the name implies, this theory is about using subtle, indirect suggestions that are evidenced-based to change employees into making the changes required. For this to be successful you must define the change, take into account the employee’s point of view, offer proof that the change is valid and it’s a choice, listen to feedback, limit options and offer short-term wins to solidify the change.

Change Management Process

Change management can take many forms. From small projects to large organizations, we all must deal with change and there’s no single approach when it comes to it. However, here are some steps you can follow to guide you through the change management process.

1. Define the Change

First, it’s important to define what the change is and general information about it so you and your team know how to proceed. Ask yourself questions about the change, such as whether is it planned or unplanned. Will it have an incremental rollout, or will it need a faster implementation? These questions will help you gather information about the change so that you can create an effective change management plan. Make sure you use change orders to control change in your projects, programs and portfolios.

2. Create a Change Vision

Your change vision is a description of what your organization will look like after a change has been successfully implemented. Similar to a gap analysis , it describes the difference between the current state and the desired future state and the expected benefits for the project or organization.

3. Select a Change Management Model

There are several change management models you can choose from, each with its own pros and cons depending on the specific characteristics of your project or organization.

4. Create a Change Management Plan

A change management plan explains how the change will be managed, either at the project or organizational level. It describes what are the change management roles and responsibilities, who is on the change control board , how will the change request process work, and any other details that are related to change management.

5. Assemble a Change Management Team

Your change management plan has all the strategies, guidelines and procedures that you will use to manage change. Now you’ll need a team to execute them. Assemble a cross-functional team , so that you have different perspectives to analyze change.

6. Implement & Track the Changes

The work isn’t done once you’ve implemented a change in your project or organization. It’s important to follow up and track the impact of your changes using data and key performance indicators (KPIs).

Change Management Templates

Here are some free templates that can help you with change management at the project level. We also have dozens of project management templates to help you with planning, scheduling and tracking.

Change Request Template

This free template is ideal to streamline your change request approval process. It can be easily customized and shared with your team.

Change Order Template

Change orders are a fundamental project change management document. This free template is ideal to get you started.

Change Log Template

This change log template is ideal to keep track of every change that takes place during your project life cycle.

ProjectManager Helps with Change Management

Once you have defined your process, you need to decide on what tools you want to use to manage that change control process. Many teams turn to simple Excel templates to list change requests and track progress. Typically there are several data points you want to track when you are managing a change control process:

• Description of change request
• Who requested it
• Priority of item
• Assignee in charge of implementing change
• Date change was implemented

That’s a simple way to track the full process. Some project management software tools, however, help you manage change as a part of your project management. For example, in ProjectManager , you can track changes, along with risks and issues, right in the software.

The benefit of incorporating change management into your PM tool is:

• Track changes with the project
• Attach change requests to specific tasks
• Get email alerts when changes are updated
• Track changes on a dashboard.

When changes are connected to particular projects, or even when you make organizational changes its own project, it can help to use tools that keep your process moving forward through automation and tracking capabilities. Whatever tool you use, be sure to remember that change must be led. While change happens, managing change takes leadership.

Change happens, but without the right tools to manage that change, it’s the change and not you who is directing the project. To have a strong change management process, you must have an able change management tool. ProjectManager is online project management software that gives you real-time data so you can identify change as it’s happening. Then you have the features you and your team require to resolve those changes. Get started with ProjectManager for free and manage change by taking this free 30-day trial.

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An Agile Approach to Change Management

• Sarah Jensen Clayton

Six lessons on moving quickly under pressure.

In the wake of Covid-19, organizations are fundamentally rethinking their product and service portfolios, reinventing their supply chains, pursuing large-scale organizational restructuring and digital transformation, and rebuilding to correct systemic racism from the ground up. Traditional change management process won’t cut it. The author borrows from agile software development processes to reinvent the change management playbook.

The business world has arguably seen more disruption in the last nine months than in the last nine years, bringing new and urgent demand for change. Initiatives are being launched by the dozen, adoption can’t happen fast enough, and the stakes are higher than ever. In the midst of a Covid-induced recession, and with some industries on the brink of extinction, change isn’t about fine-tuning — it’s existential.

• Sarah Jensen Clayton is a senior partner with Korn Ferry , co-leading the firm’s culture, change, and communications capability globally. Sarah’s range of expertise includes leadership alignment, change management, culture transformation, M&A and restructuring, diversity, equity and inclusion, employee engagement and internal communication, among other things. She frequently works at the intersection of crisis management and culture transformation, helping leadership teams to recover reputation and drive behavioral change.

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Change Management

Table of Contents

What is change management.

Change management is the methodical approach an organization takes to transitioning or transforming its plans, processes, or technologies. Its purpose is to create a framework for effecting, controlling, and helping people to adapt to organizational shifts in a way that minimizes disruption and maximizes benefits.

We can characterize the modern business environment by rapid transformation — whether that’s technological advancements, buyer or employee preferences, globalization, or unplanned global events like the COVID-19 pandemic.

But ~70% of change initiatives fail. The ones that don’t have one thing in common: they’re well-planned. And that’s where a strategic plan comes in.

• Organizational change management
• Strategic change management
• Technology change management

Understanding Change in Business

“Organizational change” refers to a business’s actions toward changing or adjusting a significant component of its organization. You might implement an organizational change to improve efficiency and productivity, respond to market trends or competition, or adapt to new laws and regulations. Or, you might be scaling your company and need to adjust your organizational structure accordingly.

Some areas of change include:

• Company culture
• Corporate hierarchy
• Technology and infrastructure
• Internal business processes
• Employee roles and responsibilities
• Product innovation

There are various reasons why organizational change might be necessary. Regardless of the cause, the process requires careful planning and management to ensure a smooth transition.

The 2 Types of Organizational Change

Broadly speaking, change in busienss falls into one of two categories: adaptive or transformational.

• Adaptive changes are small and gradual. Businesses make them in response to specific needs or challenges, and iterate them over time. When you hire a few new sales reps to meet growing product demand, test a new sales methodology , or introduce a hybrid/remote work policy to attract top talent, you’re making an adaptive change.
• Transformational changes are large-scale overhauls. They’re a departure from the status quo and are often the result of substantial market shifts, external pressures, or long-term goals. When a company rebrands itself, launches an innovative new product, or taps into international markets, they’re making a transformational change.

In either case, change management is the process of guiding these changes to successful implementation. That involves thorough scenario planning, clear communication with team members, and frequent progress tracking and adjustments (especially where changes are transformational, sudden, and unplanned).

The Kübler-Ross Change Curve

The Kübler-Ross Change Curve , originally developed by Elisabeth Kübler-Ross in her work on personal transition in grief and bereavement, is widely applied in corporate change management. It helps leaders understand how their team members react emotionally to significant change. From there, they can tailor communication and support to help the team navigate the transition.

This model highlights five stages of natural emotional responses to change: denial, anger, bargaining, depression, and acceptance.

In this initial stage, individuals often resist the change because they hope it won’t actually happen (or won’t affect them personally). It’s a defense mechanism they use to cope with the initial shock, leading to a temporary drop in productivity as individuals cling to familiar ways and resist the emerging reality.

As the reality of the change begins to set in, they experience frustration, often looking for someone to blame. This emotional response can manifest in various ways, potentially creating conflict within organizations as individuals express their dissatisfaction or fear about the future.

3. Bargaining

Moving past anger, they look for ways to avoid or minimize the impact of the change. Employees in this stage negotiate for a more favorable outcome or attempt to make compromises, reflecting a desire to regain control or mitigate losses.

4. Depression

Acknowledging the inevitability of the change can lead to a sense of loss and sadness, as individuals “mourn” the way things used to be. At this stage, low morale and productivity are commonplace as people may feel overwhelmed by the changes and uncertain about their future.

5. Acceptance

Eventually, team members begin to accept the reality of the change and start looking for ways to adapt constructively. This stage is marked by a renewal of energy and focus as people explore new opportunities and learn to work within the context of the new reality. In other words, they integrate the change into their routines and behaviors.

Of course, your team members probably won’t feel “depressed” or “angry” at an organizational shift. Those words are a bit dramatic. But they will show resistance, dissonance, and a lack of adoption according to the Change Curve, which will hinder successful implementation or prevent it altogether.

The Change Management Process

Any organizational change initiative requires thorough planning and execution. Let’s look at the essential steps involved in managing change:

1. Preparing your team members

The most important first step is to lay the groundwork. That’s the only way you stand a chance at successfully transitioning your team to a new way of working. Cultural preparation is the first step here.

In this phase, your leaders need to focus on helping employees recognize the need for a change initiative and understand why it’s crucial for the company’s success. They communicate the problems the organization faces and try to create dissatisfaction with the status quo.

Essentially, the purpose here is to get initial buy-in from employees to avoid the friction outlined in the Kübler-Ross model.

2. Planning for organizational change

After you have buy-in from most of your team members, you can move on to the actual planning. Here, you’ll form your change management team, create a vision, and start mapping out the details of your transition.

Some common activities at this stage include:

• Conducting a thorough impact analysis
• Pinpointing strategic goals
• Identifying key stakeholders and influencers
• Defining their roles in the change process
• Defining the benefits and expected outcomes of the change
• Creating an actionable project plan with a clear timeline and deadlines

While it’s important to define the discrete actions your organization will take to achieve the end goal, you’ll also want to account for unexpected issues and setbacks. Things like risk assessments and contingency planning should occur in this phase.

3. Implementation

Once you’ve planned everything out, all there is left is to put that plan into action. Whether that’s a structural, strategic, or technological change depends on the specific type of transformation you’re pursuing. Either way, communication and cross-functional alignment are absolutely critical.

A few things change managers can do to ensure a smooth transition during this stage include:

• Celebrate progress and small wins to keep morale high
• Actively listen and address team members’ questions, concerns, and challenges
• Adjust plans based on feedback from team members
• Provide the tools and resources necessary for team members to adapt to the change

4. Integrating changes with organizational culture

Once the change has been implemented, it’s essential to make sure it becomes a part of your organization’s culture. You’ll have to embed new processes, procedures, and ways of thinking into day-to-day operations. This is especially crucial for internal business process changes, like sales innovation or switching CRMs.

The goal here is to prevent team members from sliding back into old procedures and solidify long-term adoption of the changes. Of course, that isn’t something that happens right away or even weeks after execution. It requires change managers to consistently examine employee behavior, performance, and progress and guide them toward fully embracing the change.

5. Project review and analysis

Although this is something you’ll look at continuously, take a step back after a few months and assess the overall impact of your change management process.

• Did you achieve your organizational goals?
• Have your employees adopted the new practices?
• Are they happy with the way things are going?
• How has productivity changed within the company?

Also look into issues that still need addressing. There were probably unexpected challenges or roadblocks that came up during the process. Take the time to identify and resolve those before they become long-term problems.

Technology Change Management

In 2023, Flexera studied over 500 IT execs and found that 73% of businesses saw digital transformation as a top priority. Managing technology changes within organizations presents unique challenges, however, specifically when it comes to user adoption, training needs, and resistance to new systems.

To ensure effective technology change management, here are a few essential practices to keep in mind:

• Involve users from the start. Get user feedback and input during all stages of purchasing, planning, and testing. This will help increase buy-in and decrease resistance down the line.
• Take an agile approach. Agile processes like Test-Driven Development, pair programming, and regular retrospectives can promote a more flexible and iterative approach​​.
• For large projects, use phased implementation . Implement parts of the software in phases or test it on smaller groups within your organization. This builds on agile principles and allows for adjustments after each phase based on feedback and results.
• Provide training and support to promote user adoption. Tailor training programs to meet the specific needs of different user groups and offer ongoing support to address any issues or concerns that arise​​.
• Identify your “change champion.” Place leaders and department heads in a position to guide others through the change and be an advocate for it.

Change Management Frameworks

There are several different change management strategies. The one you use depends a lot on your organization’s culture and the type of change you’re implementing.

Here are four popular approaches:

Kotter’s 8-Step Change Model

Developed by John Kotter, the 8-Step Change Model focuses on facilitating change through a mix of top-down and bottom-up approaches. It emphasizes the importance of leadership, communication, and employee involvement in the change process through the following steps:

• Creating a sense of urgency
• Building a “guiding coalition” (change management leaders)
• Forming strategic visions and initiatives
• Enlisting a “volunteer army” (champions for the cause)
• Removing barriers to implementation
• Creating short-term wins
• Maintaining that momentum
• Articulating the relationship between new behaviors and broader success

This framework is ideal for large-scale organizations undergoing significant transformations that require a new vision or a substantial shift in direction.

ADKAR Model

Created by Prosci founder Jeff Hiatt, the ADKAR Model prioritizes an individual-oriented approach to change management, focusing on…

• Awareness (at every level of the organization)
• Desire (to support it)
• Knowledge (of how to make it actually happen)
• Ability (to make it happen)
• Reinforcement (that the change is worthwhile)

…to ensure the change is successful at both an individual and organizational level​​​​.

It’s particularly effective in environments where change success depends heavily on individual employee adoption and usage. When you’re implementing new technologies or processes that employees will interact with daily, you need each step of the ADKAR Model to ensure your change lasts long-term.

Lewin’s Change Management Model

This classic change management model, developed by Kurt Lewin , involves three steps:

• Unfreezing the current processes
• Making the change
• Refreezing to solidify the new processes in place​​​​

Lewin’s model is most effective for straightforward, linear changes you can clearly delineate into stages. It is especially useful for smaller organizations or individual departments within larger entities where changes can be contained, monitored, and stabilized effectively.

McKinsey 7-S Model

The McKinsey 7-S Model analyzes organizational effectiveness by looking at seven interdependent elements:

• Shared Values

It’s ideal for complex organizational changes where multiple elements of an organization are affected simultaneously. It verifies you’ve considered and aligned all relevant elements, making it effective for enterprise strategic changes or integrative efforts post-merger or acquisition​​​​.

The Prosci Methodology

This methodology includes tools and processes based on research to facilitate successful change management. It integrates three main components:

• ADKAR Model (mentioned above)
• Prosci Change Triangle (PCT)
• Prosci 3-Phase Process

This comprehensive, multifaceted framework works well for organizations committed to a research-based, structured approach to change management. It’s applicable across a wide range of industries and company sizes, but it is particularly beneficial in organizations where change needs to be scaled across multiple teams or departments​​.

Examples of Successful Change Management

To help you grasp what change management looks like in practice, let’s take a look at two successful examples:

JPMorgan Chase & Co.

With a team of 270,000+ employees around the world, companywide changes at JPMorgan Chase & Co. are near impossible without a proper change management strategy. Post-COVID-19 pandemic, profits surged to $11.7 billion in Q3 2021 from $9.4 billion that same time the year prior.

The company attributes its recent success to its ability to effectively harness artificial intelligence (AI) and cloud technologies — “ more than 300 AI use cases in production ,” to be exact.

To drive successful AI implementation across such disparate teams, the firm brought on 1,500+ employees dedicated to new AI developments, data management, and cloud technology. At the employee level, they continuously test the newest ways to use AI applications to improve productivity and make their lives easier.

Blackwoods is a top industrial and safety products provider in Australia and New Zealand with over 55 branches across Australia and New Zealand. When the pandemic struck, they had a huge problem with legacy training methods (which weren’t adapted to remote work in a field where on-site training is practically required).

They utilized WalkMe’s Digital Adoption Platform to migrate to Microsoft Dynamics, distribute training materials, automate processes, and guide staff through the transition to working and training remotely.

The implementation, guided by the change management platform, led to notable operational improvements — 50% faster time-to-proficiency, 15% faster quoting processes , and significant time savings.

Change Management Best Practices

Successful change management varies from company to company. Even within the same organization, each individual initiative requires a completely tailored approach.

However, there are best practices to keep in mind when planning for, implementing, and solidifying organizational changes.

• Incorporate team member feedback and participation at every step of the change management process ( only 42% of employees say their company included them when creating a change strategy).
• Communicate clearly, consistently and often to ensure all stakeholders are informed and on-board with each element of the change.
• Equip managers with the necessary skills to effectively lead teams through the shift.
• Prepare a strong support system for employees to prevent burnout, reduce stress, and facilitate employee resilience during times of change.
• Gauge employees’ levels of resistance according to the Kübler-Ross Change Curve beforehand and as you execute your strategy to find points of vulnerability and address them proactively.
• Monitor and track progress throughout for effective decision-making, course corrections, and assurance that the change is sticking.

People Also Ask

What are the 5 c’s of change management.

The 5 C’s of change management are Clarity, Communication, Commitment, Culture, and Capability.

How do you get employee buy-in for organizational change?

The #1 way to get buy-in from employees is to involve them at every step of the change management process. Before implementation, gather input from them to understand their needs and concerns. During the change, give positive reinforcement and recognition for small wins, and attribute broader success to your change initiatives.

What are the responsibilities of leadership in organizational change management?

In change management, leadership is responsible for defining and communicating the vision, inspiring and mobilizing commitment, providing resources and support, modeling the desired changes, and monitoring progress while adjusting strategies as necessary to ensure successful implementation and sustainability of the change.

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• Glossary: Product Lifecycle Management

The basics of change control and its importance

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What is change control?  

“The process through which all requests to change the approved baseline of a project, programme or portfolio are captured, evaluated and then approved, rejected or deferred.”   APM Body of Knowledge, 7th edition

Change control is a process and shouldn’t occur in isolation, or without consultation. It’s important to note that it’s distinct from change management , which can include wide-ranging strategic change within an organisation. However, both are common, inter-related features of many projects. At a minimum, the change control process should include a discussion between the project manager and sponsor. As part of the planning stage of the project, you’ll need to get approval for the project baseline. Change control helps to manage any changes to this baseline.  

Change control is about ensuring that any change to the baseline of your project doesn’t adversely affect other parts of your project. A project is made up of various moving parts and you’ll need to consider the effect that making a change in one area will have on the others. To do this, you need to establish your change control process and ensure there is an ongoing audit of significant changes .  

The change control process 

1. log change request.

The first step in a change control process is to log the request. Keeping a change log is important, as it gives you oversight of requested changes. It should include a description of the requested change, when the change was requested and who it was requested by.

2. Initial evaluation

The initial evaluation stage is where we first determine the viability of the change. This stage gives us the opportunity to assess change requests quickly and not invest lots of time into evaluating unrealistic changes. For example, if you were to build a car and receive a request to change it from a four-wheeled to a three-wheeled car, this change would be rejected outright due to the excessive rework required. Initial evaluation is not about saying yes or no to the change happening, it’s about saying yes or no to investigating the change further. The outcomes of this stage will either be reject or proceed .

3. Detailed evaluation

Once you’ve determined that a change is not immediately non-viable, you can do a more detailed evaluation. Detailed evaluation is where we dig into the detail of the change. Some of the questions you might ask are:  

• What impact will the change have on the overall project outcomes?   
• Does this impact other areas of the project?   
• Will the knock-on effects of the change be too severe for us to handle?   

A particular focus needs to be on how this change will impact other areas of the project. There will almost certainly be effects on other project elements even if we only make a change in one area. For example, we are building a car and receive a request to make it a five-door car rather than a three-door car. We need to re-evaluate our design, our budget and our materials and consider our resources and timeline. We need to determine if this change is feasible within our project.   

Our detailed evaluation should produce some kind of report on the impact of the change. It should:  

• Break down the advantages and disadvantages  
• Explain the impact on budgets and timelines   
• List potential benefits or risks that would come as a result of the change  

As part of the detailed evaluation, the project manager and sponsor may consult the person who requested the change to understand why they requested it. They might also seek advice from subject-matter experts who can advise on the viability and necessity of the change. 

4. Recommendation

The detailed evaluation leads to a recommendation. The recommendation will provide a decision on the change. There are generally three recommendation options:   

• Approve: the project accepts the change.  
• Reject: the project rejects the change. After assessing all of the evidence, the project manager and sponsor are not satisfied that the change can be made without derailing the project. An explanation for the rejection is given to the person who requested the change.   
• Defer: the project manager postpones a decision. This can happen for a number of reasons, such as the project manager not yet having enough information. There might also be critical factors to consider that are yet to come into play. An explanation is given to the person who requested the change and a timeline set for when the change will be reviewed. 

5. Update plans

The project manager updates the plans. This includes setting out how to introduce the change and updating plans for other areas of the project, budgets and timelines as required.

6. Implement change

Finally, we can actually implement our change. We have updated our plans and can move forward with the project with the change incorporated.   

Change control is an essential part of project management. It ensures that any changes that you make to the established project baseline are undertaken in a managed way. Following a change control process, making good use of the two-stage evaluation process and ensuring your plans are clearly updated will enable you to effectively control changes within your project. Ultimately, utilising change control will enable greater project success.  

You may also be interested in:

• APM Enabling Change SIG podcast series, interview with Freddie Stephenson
• How do project managers control the decision to make a change?
• What is change control?

Felicity Goldsack is a Project Management Training Consultant at Parallel Project Training . She manages Parallel’s in-house study guides alongside bespoke course and material development for clients. A regular contributor to Parallel’s blog and the project management news site Project Accelerator , she writes articles covering project management principles for beginners.

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More From Forbes

4 steps for effective change management.

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Tim York is the Chief Growth Officer of leading accounting and consulting firm FORVIS .

Several years ago, a blue-chip tech company switched CEOs, and that leader quickly discovered that its salespeople were vying with each other for client business. Clients were called, and even nagged, repeatedly by competing forces within the same company.

While the CEO rightly put a stop to that sales behavior, it was far from smooth. Company leaders failed to articulate why a new change was critical for the organization, the client and—most importantly—the sales team.

The net result: It took nearly a decade (yes, you read that right) for the company to right the ship and become unified.

In today’s world, most companies don’t have a decade to pivot and correct mistakes, and in some cases, some may have only a couple of quarters to effectively deal with change.

Change in the workplace is a virtual inevitability. Personnel changes, new service offerings, various disruptors, company strategy shifts, and mergers and acquisitions can all bring about anxiety or uncertainty for employees, customers, vendors and more. That sense of unease can be exacerbated through a company merger or acquisition where the combined workforce often wonders—and worries—about their futures. Furthermore, the speed of a transaction and the immediacy of something different can drive difficulties.

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Through all the uncertainty, those organizations that adhere to a four-pronged change management structure and related processes are more apt to weather change and thrive in their new environment. Those four steps focus on explaining the purpose of the change, articulating how the change will be designed, testing or piloting the idea, and deploying and measuring the effectiveness of the new workplace structure.

Plan With Purpose (The Why)

Purpose involves building the business case for the change and answering not only what you want to do but why it is important. Executives who focus on the impact on the various stakeholders and end users enable the creation of a compelling vision complete with “What’s in it for me?” statements geared specifically to the constituents being addressed.

It is during this critical first phase that you look at change from a systemic lens and determine the cadence and pace of change in the context of what else is taking place in the organization. By focusing on the impacts of change across your organization, you can make intelligent and purposeful decisions regarding timing. Prioritizing change initiatives in this way helps avoid change fatigue and allows your organization to maximize the benefits of the change.

Careful Design (The How)

Design is where you answer the question of how you will pull off the change. Change, from our company’s perspective, is a team sport. That means we want many fingerprints on the plan for how we roll out the change. Collaboration is the name of the game here.

It builds buy-in, fosters a feeling of ownership in the change and, perhaps most importantly, allows for a stronger, more robust plan execution by including the input and insights of those most impacted by the change. In particular, you need to create an environment where people feel empowered to participate, provide feedback, ask tough questions and feel ownership for the successful execution of the change initiative.

Pilot Your Plan

The third element of the change management process is to pilot your plan. It is important to test change/solutions before fully deploying to discover those so-called “bugs” and to create what we like to call a “closed loop learning environment.” Those who are involved in the testing process often become early adopters and, in fact, change champions for the rollout.

Deployment Requires A Road Map

Deployment is the final element of our change management process. To deploy successfully, you need a clear road map, complete with measurable milestones along the way. This allows individuals to see the progress being made. It also leaves room for the all-important celebrations throughout the process.

In addition, your company needs to develop a solid training plan designed to give end users the knowledge, skills and tools necessary to be successful. A strategic communications plan will help bring people along as the information needed to be successful is shared in a just-in-time fashion.

It doesn’t end there. You need to ensure there is a robust support system in place for employees when they have questions, experience anxiety or need reassurance.

Finally, measuring and monitoring the change closely allows for the inevitable tweaks and pivots that will be required. That will also provide opportunities to celebrate “wins” early and often.

Final Thoughts: Evaluating Next Steps, Considering ROI

Companies sometimes struggle with understanding whether they should hire a change management officer. I believe that our strong commitment to managing “white water change”—as we did with our 2022 merger between DHG and BKD to create FORVIS—helps to accelerate adoption and build what we call “change muscle” across the organization.

But I also recognize that not every organization will hire someone for that role. So, unless your organization has the capacity to hire a chief change officer—as we have done with Jeff Outten leading our team—my advice would be to make change management a priority of your organization’s senior leadership.

There are some clear benefits, as well. For our company, purposeful, intentional change management has allowed us to accelerate positive and effective change together. That has led to enhanced employee experiences, a culture of engagement, retaining our pre-merger client experience metrics and more.

In the end, I believe that is what every company is striving for.

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Your guide to the art of organizational change management 

Every organization goes through periods of change. Some changes are significant, with a wide-ranging impact, while others are simpler and relatively contained.

In truth, most organizations are always changing in one way or another. That’s a good thing. Change is vital for growth , innovation and competition .

Still, it can be disruptive for employees, customers and other stakeholders. Excitement can quickly turn to anxiety. Unfamiliar processes, fear of the unknown, and potential resistance to change can undermine the potential benefits of changes both large and small.

In an era when the pace of change is accelerating at unprecedented rates , the ability to navigate and manage organizational change has never been more critical.

If you lead a team, whether that means one employee or 100, learning the art of organizational change management (OCM) is crucial.

In this guide, we’ll share insights and best practices to help you:

• Understand the principles of organizational change management
• Guide your team with empathy and confidence
• Keep one eye on future opportunities without losing sight of current performance

Change comes in many forms, from strategic transformations and technological adoptions to cultural shifts and structural reorganizations. But with preparation and the right tools, your team will be ideally positioned to minimize disruption and maximize the benefits.

Table of Contents

What is organizational change management, what causes organizational change.

• The essential skills of organizational change management 

Conquering the art of organizational change management

At its core, organizational change management is a structured framework that addresses the human side of change within an organization. 

It involves planning, implementing and sustaining change initiatives by guiding individuals, teams and organizations from their current state to a desired future state. 

Unlike traditional change management, which might focus solely on project management or technical aspects, OCM takes a more holistic view. It recognizes the importance of leadership, culture, and communication in facilitating change.

A brief history of OCM

The history of organizational change management, at least in the formalized sense, is hotly debated. After all, as long as there have been organizations (in business, culture and society) there has been change and the need to manage it.

What we do know is that the current evolution of OCM started to take shape around the late 1990s. This likely coincides with the pace of change itself picking up, thanks to rapid globalization and technological advancement. 

Around that time, the rhetoric starts to shift from rigid top-down change management models to ‘managing at the pace of change.’ In other words, moving with the times.

Why this approach is more important than ever

If the pace of change during the late 90s and early 2000s was considered fast, then we’re moving at warp speed today. 

According to PwC, the percentage of CEOs who think their organization won’t last a decade without transforming has risen from 39% to 45% in the last year alone.

“Your choice is stark: either change the company to enable survival or risk having change forced upon it.”

• PwC, The CEO’s 2024 agenda

It’s a bleak outlook, but they’re not wrong. Organizations must evolve – and fast. 

The business landscape is constantly evolving. You could say that life, or human nature, is the cause of change. It’s one of those things that just is.

But that’s not a useful answer. So let’s look at some of the common catalysts that spark a need for leaders to draw on their organizational change management skills:

• New leadership bringing fresh perspectives and new strategic goals. This can necessitate changes in processes, workflows, or even company culture.
• Team restructuring to allow for growth and adaptation. This could mean redefining roles, introducing new teams or restructuring departments to align with the organization’s goals.
• Technological advancements like the rise of AI (an external factor) or the rising popularity of time management tools (an internal prerogative) often require employee training and workflow adjustments.
• Evolving business models due to changing market dynamics, customer preferences or competitive pressures, all of which require adaptation to remain relevant.

Two types of change

All the change catalysts above – and the dozens of factors we haven’t listed – can be broadly categorized as “adaptive” or “transformative.”

• Adaptive changes are typically incremental changes that address evolving needs or challenges. They often require minimal disruption and can be implemented relatively quickly. Think of things like upgrading software, hiring a new colleague, or trialing new time management strategies within a team.
• Transformative changes are far-reaching and radical shifts that can affect the organization’s strategy, structure, culture or operations at a foundational level. They’re more complex and require planning and resources. Transformational change can include merging with another company, implementing an organization-wide time management tool, restructuring a department or launching a new product line.

Of course, few things are black and white in business. Most change management challenges you’ll face as a leader fall somewhere between adaptive and transformative. 

Time management tools are a great example of this. Although the eventual goal is to transform your organization with wide-ranging workforce analytics data in one centralized location, it’s more likely that you’ll start with a pilot implementation and scale up.

That’s how Executive Mosaic approached the change , starting with a controlled Time Doctor trial before implementing the platform for the entire workforce. 

Crucially, the rollout coincided with COVID-19 restrictions. However, because Executive Mosaic’s management team had seen the outcomes of an adaptive change, they were ready for the transformation.

“It looked like a stroke of unintentional genius,” said Executive Mosaic CEO Jim Garrettson. “We were just lucky to be ahead of the curve.” 

This is just one example of the need for robust and flexible organizational change management skills. The changes today’s leaders face are more complex and wide-ranging than ever, with ramifications nobody can predict. 

Imagine telling one of the leaders who pioneered ‘managing at the pace of change’ in the 90s about the global pandemic that hastened the transition to remote and hybrid work, and AI’s double-edged role as facilitator and disruptor .

The essential skills of organizational change management

Let’s step back for a moment and revisit something that we might have sped past earlier.

That’s the idea that OCM ensures a smooth transition by focusing on the human element of change .

Modern organizations are increasingly made up of subject-matter specialists who excel in their field. If your field is managing your team of experts while minimizing friction, you’ll go far.

We can’t afford to let organizational change management become a lost art. As exciting as AI, globalization and remote working are, their potential will remain unrealized without leaders who understand that successful change isn’t just about implementing new technologies or processes; it’s about people adapting to new ways of working.

Leadership commitment

Change doesn’t always begin at the top anymore. Sometimes it does, but culture is one example where leadership buy-in becomes important in capturing the potential benefits of transformative change. 

Still, any change initiative needs the leadership team’s unwavering support. Executives and top-level leaders must champion the change, clearly communicate its purpose and benefits, and be visible throughout the process.

Team leaders and department heads become mission-critical conduits, translating employee feedback to organizational leaders and maintaining a clear line of sight that’s important for trust.

Vision and objectives

There’s increasing evidence that an employee’s sense of purpose is a powerful motivator for performance and engagement. For you as a leader, that means clarifying the strategic need for change, securing leadership buy-in, and sticking to the vision for the entire process. 

A clear and compelling vision for the organization’s future state is essential for guiding change. 

Translating the vision into specific, measurable objectives provides a roadmap for the change effort that everyone can work towards.

Communication strategies

Effective communication is the engine that keeps organizational change moving in the right direction. 

Employees need to be informed about actions and timelines, and how they’ll be impacted.

This is easier for adaptive changes, as the time between kick-off and post-project review is relatively short. But fatigue can creep in over longer or more complex transformations.

Here are a few things you can do to keep the communication engine purring throughout the change:

• Establish a cadence for communication so employees know when to expect updates
• Make it manageable, ensuring every update adds value, and don’t over-communicate
• Communicate challenges transparently alongside the wins
• Ask for – and act on – feedback from affected employees

Consider setting up a dedicated comms channel for employees to view the latest updates and provide feedback. This makes communication more two-way and helps foster a sense of ownership. 

Support structures and mechanisms

Change can be challenging. 

Leaders need to architect or build support structures, such as training programs, mentorships, contribution opportunities and internal communication channels to help employees navigate the transition. This also includes mechanisms for dealing with resistance, feedback and non-adoption.

Start early. Design the systems proactively, with room to adapt as things inevitably change.

If you’re working with an external vendor, for example, when rolling out time management tools or transitioning to a new CRM, seek their advice on strategies to manage organizational change.

At Time Doctor, we’ve compiled our experience from 200k+ users into organizational change management resources , including emails, best-practice guides and communication support. They’re free to download and personalize as you need.

You’re living (and leading) through a period of unprecedented change. While that’s exciting, and change is inevitable, it can also be daunting.

By equipping yourself with the knowledge and tools of organizational change management, you can transform challenges into opportunities and maximize the potential benefits of organizational evolutions – even the small ones.

Just remember that successful OCM is all about people. It’s about transforming how you think, work, and lead to get the most out of an engaged team and create a future that aligns with your vision and values.

Focus on clear communication, strong and empathetic leadership , and employee support, and you’ll ensure a smooth transition.

Time Doctor can be your partner in navigating change

Our workforce analytics platform provides valuable insights into team activity and performance, helping you identify training needs, monitor progress, and measure the impact of change initiatives.

Sign up for a free trial to start gathering the insights you need to help your team work more effectively by the minute.

Book a free demo of Time Doctor

Andy is a technology & marketing leader who has delivered award-winning and world-first experiences.

Engineering team structure essentials: Building, evaluating, and improving

Innovate, adapt, succeed: refining your hr team structure, related posts, leadership: improving decision-making with organizational design, aligning vision and structure: organizational design for success, keeping talent: how organizational design can improve retention rates, building a team structure that supports employee development: 5 key strategies.

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• Published: 02 April 2024

A practical evidence-based approach to management of type 2 diabetes in children and young people (CYP): UK consensus

• Billy White 1 ,
• S. M. Ng 2 ,
• J. C. Agwu 3 ,
• T. G. Barrett 4 ,
• N. Birchmore 5 ,
• M. Kershaw 4 ,
• J. Drew 6 ,
• F. Kavvoura 7 ,
• C. Moudiotis 8 ,
• E. Procter 6 ,
• P. Paul 9 ,
• F. Regan 10 ,
• P. Reilly 11 ,
• P. Sachdev 6 ,
• R. Sakremath 12 ,
• C. Semple 13 ,
• K. Sharples 14 ,
• M. Skae 15 ,
• A. Timmis 16 ,
• E. Williams 17 ,
• N. Wright 18 &
• A. Soni   ORCID: orcid.org/0000-0002-2586-4337 18  

BMC Medicine volume  22 , Article number:  144 ( 2024 ) Cite this article

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Metrics details

Type 2 diabetes in young people is an aggressive disease with a greater risk of complications leading to increased morbidity and mortality during the most productive years of life. Prevalence in the UK and globally is rising yet experience in managing this condition is limited. There are no consensus guidelines in the UK for the assessment and management of paediatric type 2 diabetes.

Multidisciplinary professionals from The Association of Children’s Diabetes Clinicians (ACDC) and the National Type 2 Diabetes Working Group reviewed the evidence base and made recommendations using the Grading Of Recommendations, Assessment, Development and Evaluation (GRADE) methodology.

Results and discussion

Young people with type 2 diabetes should be managed within a paediatric diabetes team with close working with adult diabetes specialists, primary care and other paediatric specialties. Diagnosis of diabetes type can be challenging with many overlapping features. Diabetes antibodies may be needed to aid diagnosis. Co-morbidities and complications are frequently present at diagnosis and should be managed holistically. Lifestyle change and metformin are the mainstay of early treatment, with some needing additional basal insulin. GLP1 agonists should be used as second-line agents once early ketosis and symptoms are controlled. Glycaemic control improves microvascular but not cardiovascular risk. Reduction in excess adiposity, smoking prevention, increased physical activity and reduction of hypertension and dyslipidaemia are essential to reduce major adverse cardiovascular events.

Conclusions

This evidence-based guideline aims to provide a practical approach in managing this condition in the UK.

Peer Review reports

Type 2 diabetes (T2DM) in young people is an aggressive disease with a greater risk of complications leading to increased morbidity and mortality during the most productive years of life [ 1 ]. Evidence and experience are limited in this age group, with much of the data coming from observational studies such as SEARCH [ 2 ], the TODAY randomised control study and more recently GLP1 drug studies [ 3 ].

These guidelines aim to improve the care of children and young people (CYP) in the UK with type 2 diabetes. Most paediatric diabetes multi-disciplinary teams have good experience in managing type 1 diabetes and complex conditions yet relatively little experience managing type 2 diabetes and associated co-morbidities.

The Association of Children’s Diabetes Clinicians (ACDC) and National Type 2 Diabetes Working Group co-established a guideline development group, which included a multidisciplinary group of health professionals including general paediatricians, paediatric endocrinologists, diabetes specialist nurses, dietitians and psychologists. The group members agreed on the scope and subdivided topics based on areas of interest and expertise. The subgroups met independently to review the evidence base. The whole group met via teleconference over 1 year to review the evidence and make recommendations. Grading was undertaken using GRADE (Grading Of Recommendations, Assessment, Development and Evaluation).

The guideline was reviewed and endorsed by the Association of British Clinical Diabetologists (ABCD), ACDC and the British Society of Paediatric Endocrinology and Diabetes (BSPED) (Table  1 ).

Diagnosis and investigations

The main risk factors for developing T2DM are excess weight, first or second-degree relative with T2DM, maternal gestational diabetes, high-risk race/ethnicity and insulin resistance. Insulin resistance is hard to measure but associated with acanthosis nigricans, early poor growth (small for gestational age) and other associated comorbidities such as hypertension, hyperlipidaemia and polycystic ovary syndrome (PCOS).

We recommend HbA1c testing as the primary test for screening for type 2 diabetes. The choice of screening test is controversial with HbA1c increasingly recommended over the gold standard oral glucose tolerance test despite limited evidence in CYP. HbA1c does not require a fasting sample and is a predictor of vascular disease across a wider glycaemic range than just the diabetic one. However, it lacks sensitivity and would miss some people with diabetes. Testing fasting blood glucose in addition to HbA1c may diagnose some additional patients but may not be pragmatic in those unlikely to return for a fasted sample. The oral glucose tolerance test is more sensitive, but is inconvenient, more costly, has imperfect reproducibility and is less popular, contributing to poorer uptake [ 38 , 39 ].

Identification of diabetes type can be challenging with all types having overlapping features, particularly in those with excess weight [ 1 ]. Detection of diabetes antibodies identifies those at the highest risk of developing auto-immune driven loss of insulin production and can aid with the correct identification of diabetes subtype. There is insufficient evidence for the use of insulin or C-peptide levels at diagnosis.

Glycaemic targets

Intensive glucose control in adults improved HbA1c and any diabetes-related end point but not mortality [ 40 , 41 ]. No similar robust studies exist for CYP.

TODAY showed that an HbA1c of 6.3% (45 mmol/mol) or more after initiation of metformin was a predictor of eventual loss of glycaemic control irrespective of treatment arm (defined as HbA1c > 8% (64 mmol/mol)). with every 0.1% increase in HbA1c increasing risk by 16%, with a median time of approximately 11 months to loss of control [ 42 ].

We recommend that HbA1c is tested every 3 months with an overall target of < 6.5% (48 mmol/mol) which should be individualised based on circumstances.

Self-monitoring of blood glucose (SMBG)

There is no high-quality evidence that self-monitoring of blood glucose (SMBG) in CYP improves outcomes or that more intense monitoring is better. Overall adherence with twice daily SMBG was low in TODAY (59% initially, < 50% by 12 m) with greater use associated with lower HbA1c [ 43 ]. Similar findings were seen in those using insulin in SEARCH [ 44 ]. No association was found between SMBG and quality of life (QOL) or depression; however, there remains a significant financial and personal burden in monitoring without clear evidence of benefit [ 43 ].

We recommend that self-monitoring of blood glucose is undertaken in all patients in line with other international guidelines [ 45 , 46 , 47 ]. Monitoring can guide management where the diabetes subtype is not clear and where disease progression is more aggressive or rapid. Frequency should be individually tailored based on hypoglycaemia risk, availability, burden and need for treatment adjustment.

CGM and FGM

There is inadequate evidence to guide the use of continuous glucose monitoring (CGM) or flash glucose monitoring (FGM) in CYP. Inconsistent results are seen in adults [ 48 , 49 ] and there is a lack of data in CYP with type 2 diabetes. Further research is needed to identify which patients may benefit from the use of CGM and FGM and how they should be used to maximise patient benefit and cost-effectiveness.

There may be a role for the use of CGM/FGM in certain circumstances such as learning difficulties, insulin usage or as a short-term intervention during treatment intensification and education [ 46 ].

Structured education

Diabetes-structured education programmes first started in the 1970s. The focus has changed over time from a knowledge-based approach to one supporting self-empowerment. Meta-analysis of structured programmes for CYP with type 1 diabetes found no benefit of structured education versus over informal unstructured education in improving glycaemic control [ 50 ]. Similar findings were seen in adults with type 2 diabetes [ 51 ].

Two structured education programmes have been developed for CYP with type 2 diabetes but neither have undergone RCT evaluation: the TODAY Standard Education Diabetes Education (TSDE) and iCAN [ 52 , 53 ]. The iCAN programme is a bespoke group intervention delivered over four 2-h workshops with a focus on food, activity and emotional well-being [ 53 ].

Multidisciplinary team (MDT) approach

Multi-disciplinary diabetes team structure and approach recommendations are based on observational studies and expert opinion [ 45 , 54 , 55 ]. We recommend that CYP should be managed by multi-disciplinary secondary care teams with close integration with primary care and collaboration with adult diabetes teams. Teams should include dietitians, paediatric nurses, diabetes educators, psychologists, social workers (sometimes called community/cultural workers) and medical doctors. Multi-agency working is important, including links with youth, family and social workers, and schools.

A unified approach with consistent team messaging likely improves outcomes. Telemedicine may improve access but access can be challenging (including digital poverty).

Lifestyle interventions in type 2 diabetes management in children

Lifestyle change is the cornerstone of type 2 diabetes management.

Weight loss targets

Weight loss in adults improves glycaemic control, with clinical benefits seen from 5% loss and further improvements with additional loss [ 56 , 57 , 58 ]. There is no direct evidence in young people with type 2 diabetes to recommend a target weight loss as no lifestyle RCT has aimed for sufficient energy restriction to result in 5–10% weight loss seen in adult studies.

Good diabetes outcomes are not dependent on weight loss. The highest improvement of glycaemic control in the TODAY study was seen in the group receiving rosiglitazone even though that group had the greatest increase in body mass index (BMI). However, weight loss of > 7% across all treatment groups was associated with small benefits in cardiometabolic risk factors [ 59 ].

Dietary modifications

Dietary recommendations are based on healthy eating principles for all young people and families. A healthy balanced diet is considered to be rich in wholegrains, vegetables, fruit, dairy, nuts and seeds and limits fats, oils and sugary foods. Carbohydrates should provide 40–50% of energy requirements, fat < 35% and protein 15–25%. There is little evidence to suggest other macronutrient balances at the population level; however, the ratio of carbohydrates to fat can be individualised if standard advice does not promote weight loss. Some may benefit from lower carbohydrate intake (and higher fat) whilst others benefit from lower fat.

A whole-family approach should be used to enable change across the whole family with individualisation for each family. Support from specialist diabetes dietitians is likely to be needed and should be offered to all families.

• Physical activity

Physical activity is likely to have multiple beneficial health benefits however the evidence for improvement in glycaemic control in youth is limited [ 60 ]. A 2010 systematic review found no evidence to guide physical activity modification [ 61 ] and the addition of intensive lifestyle support in TODAY improved weight but not glycaemic control [ 62 ].

Multiple cohorts show that young people with type 2 diabetes undertake insufficient physical activity: in one cohort 55.7% undertook no regular physical activity, [ 63 ] and in another only 6.5 min of moderate/vigorous activity was undertaken each day [ 64 ].

Most national guidelines recommend 60 min per day of moderate to vigorous exercise and these should also apply to those with type 2 diabetes [ 65 ].

Psychological management

Youth with type 2 diabetes have a higher prevalence of moderate or severe depression than those with type 1 (18 vs. 5% in boys and 20 vs. 9% in girls, respectively), with higher mean HbA1c and frequency of emergency department visits associated with depressed mood [ 66 ].

Over 25% reported symptoms of disordered eating behaviours in SEARCH and TODAY, such as skipping insulin, vomiting, and using diet pills or laxatives, and these behaviours were associated with poorer glycaemic control in females [ 67 ] and more severe obesity, psychological symptoms of disordered eating, and symptoms of depression [ 68 ].

Addressing psychological needs should be incorporated within everyday practice. The PedsQL (paediatric quality of life) questionnaire can be used to evaluate and monitor ongoing issues [ 69 ]. There is limited research to determine which behavioural interventions are most effective [ 4 ] and approaches could include personalised tailored interventions to their interests, health coaching and behaviour therapy and the use of peer counsellors. These are likely to need to address cultural differences and home lifestyles in order to achieve better outcomes [ 5 ].

Pharmacotherapy

Initial treatment.

Initial treatment of a CYP with obesity and diabetes should take into account that diabetes type is relatively uncertain for the first few weeks, due to overlap in presenting symptoms and a significant number presenting with ketosis [ 6 ].

Metformin should be started once any ketosis has resolved, starting at a low dose to minimise side-effects and titrated to a maximum of 2 g per day, or the maximum tolerated dose. Sustained release preparations are available and should be considered if there are GI side effects or compliance issues that could improve with reduced dose frequency [ 7 ].

Patients who present with ketosis, polydipsia, polyuria, weight loss, or have HbA1c > 8.5% (69.4 mmol/mol) should also be treated with insulin. This should be with intravenous insulin if unwell (e.g. systemic illness, not tolerating food or drink), and then subcutaneous basal insulin at 0.25–0.5 units/kg/day titrated to a maximum of 1.5 units/kg/day, pending antibody results and improved glycaemia.

There is some evidence that insulin can be successfully weaned off after initially starting it [ 8 ]. Basal insulin can be tapered over 2–6 weeks by decreasing the insulin dose by 10–30% each time the metformin is titrated up and further once metformin is at the maximum dose [ 9 ]. There is no evidence that continuing insulin will preserve B-cell function [ 10 ].

Treatment Intensification

The goal of initial treatment should be to attain an HbA1c of less than 6.5% (48 mmol/mol).

Liraglutide

Failure to achieve goal HbA1c with metformin monotherapy should prompt consideration of second-line treatment with liraglutide. Liraglutide is licensed for those aged 10 years and above with a BMI > 85th centile.

Liraglutide is given as daily subcutaneous injections and can be started at 0.6 mg daily and can be increased with 0.6 mg increments every 1–2 weeks up to 1.8 mg daily based on fasting capillary blood glucose > 6 mmol/L and tolerability.

Side effects are mainly gastrointestinal (nausea and diarrhoea). Acute pancreatitis is a rare and theoretical risk and patients should be counselled and monitored for signs including persistent, severe abdominal pain. Monitoring of pancreatic amylase and lipase should occur at baseline, after the first clinical review and yearly thereafter. If pancreatitis is suspected, liraglutide should be stopped and reported to the medicines and health products regulatory agency (MHRA) via the Yellow Card scheme.

Basal insulin therapy is the only remaining licensed treatment option if metformin and liraglutide are insufficient or not tolerated. Insulin resistance is characteristic in CYP going through mid-late puberty and might require higher doses of basal insulin up to 1.5 units/kg/day to achieve glycaemic control. A single daily long-acting insulin analogue (e.g. glargine, detemir or degludec) is preferred as studies show that compliance with insulin can be a challenge in CYP [ 11 , 12 ]. Higher concentrations of basal insulin (U-300 glargine, U-200 degludec) may be required to avoid large-volume injections that may further diminish medication adherence [ 46 ].

Additional meal-time rapid-acting insulin (e.g. aspart) may be needed if basal insulin cannot achieve glycaemic control. Doses should be titrated based on pre- and post-prandial readings and should be done in discussion with a dietitian who is supporting the young person on lifestyle changes, including diet and weight management.

The main side effects of insulin treatment are hypoglycaemia and weight gain. The incidence of hypoglycaemia is low however all patients should be educated on its treatment, including the use of glucagon [ 42 ].

SGLT-2 inhibitors

There is insufficient evidence to recommend the routine use of SGLT 2 inhibitors in CYP [ 13 , 14 , 15 , 16 ]. They can be considered for post-pubertal youth not achieving adequate control with licensed medications in collaboration with adult diabetologists.

There is a risk of euglycaemic diabetic ketoacidosis(DKA) and patients should be counselled on the symptoms and advised to seek immediate medical advice if these develop. Baseline C-peptide should be measured in those not on insulin to ensure adequate endogenous insulin production to protect against DKA. Treatment should be discontinued if DKA is suspected or confirmed and not restarted unless the cause of DKA is proven to be unrelated.

Other agents

There was insufficient evidence to make recommendations on sulphonylureas, DPP-4 inhibitors and orlistat ( Appendix ).

• Bariatric surgery

Bariatric surgery in adolescents leads to successful weight loss in those with severe obesity (BMI > 35 kg/m 2 ) and demonstrates greater weight loss outcomes when compared with lifestyle and liraglutide [ 17 ].

Bariatric surgery is the most effective current treatment available for reducing metabolic comorbidities in adolescents with remission rates of 85% for type 2 diabetes, 85% for hypertension, 75% for dyslipidaemia and 78% for musculoskeletal problems [ 18 ]. Young people are more likely to have diabetes remission than adults (86%) despite having similar weight loss [ 19 ].

Nutritional deficiencies are common in adolescents with up to 70% exhibiting some form of micronutrient deficiency [ 18 ].

The impact on pregnancy in adults is mixed, with some obesity-related problems improved and others worsened [ 20 , 21 ].

Complications and comorbidities

Glycaemic control improves microvascular risk. However, the increased risk of a major cardiovascular event (MACE) in adults is not reduced by improved glycaemic control. Additional measures including reduction in excess adiposity, smoking prevention, increased physical activity and reduction of hypertension and dyslipidaemia are essential to reduce MACE risk.

Hypertension in youth with type 2 diabetes

Treatment of hypertension in adults improves microvascular and macrovascular outcomes at least as much as improvement in glycaemic control [ 41 ]. It would be reasonable to suggest a similar improvement in outcomes could be achieved in CYP.

Blood pressure in children should be interpreted in relation to age, sex and height using appropriate centile charts [ 22 ]. Hypertension in children under 13 years of age is defined as a systolic and/or diastolic blood pressure that is greater than the 95th centile on three or more occasions and > 130/80 in those over 13 [ 23 ]. Ambulatory blood pressure monitoring can assist in the diagnosis and exclude those with white coat hypertension.

Weight loss, salt reduction and increased physical activity can improve blood pressure. ACE inhibitors should be used where blood pressure is not responsive to lifestyle change. Electrolytes should be measured at baseline and 4–6 weeks and adequate contraception is in place to avoid teratogenic side-effects.

Dyslipidaemia

Dyslipidaemia is an important modifiable cardiovascular disease (CVD) risk factor. The classic lipid profile seen with obesity, insulin resistance and type 2 diabetes is raised triglycerides and decreased high-density lipoprotein cholesterol (HDL-C) levels. Earlier identification and control of dyslipidaemia reduces the risk of atherosclerosis in early adult life. Treatment of children with familial hypercholesterolaemia shows a reduction in subclinical atherosclerosis [ 51 ].

Dietary changes can improve dyslipidaemia and should be attempted for 6 months. Statins should be initiated where LDL-cholesterol remains > 3.4 mmol/L. Liver enzymes and CK should be monitored to detect rare liver side-effects and avoidance of pregnancy with adequate contraception is advised to avoid teratogenic side-effects. Fibrates should be used to avoid pancreatitis where triglyceride levels are very elevated.

Non-alcoholic fatty liver disease (NAFLD)

NAFLD is a histopathological spectrum of liver disease, from early benign steatosis to non-alcoholic steatohepatitis (NASH) and cirrhosis. It contributes to the development of T2D, cardiovascular disease and chronic kidney disease [ 24 ]. T2D is one of the strongest clinical predictors of disease progression [ 25 , 26 , 27 ]. Steatosis is present in 25% to 50% of adolescents with type 2 diabetes and more advanced disease is increasingly common.

Screening method choice is controversial, and all are poor at differentiating disease severity. Liver enzymes should be tested at baseline and yearly thereafter. Abnormal liver function tests (LFTs) should not be attributed to NAFLD without exclusion of alternative diagnoses. Alanine transaminase (ALT) can be normal in severe disease and clinicians should have a high index of suspicion [ 28 , 29 ]. Referral to a hepatologist or gastroenterologist is recommended where liver enzymes remain over 3 times the upper limit of normal despite the treatments listed below [ 28 , 29 ].

Ultrasound should be performed at diagnosis and up to 3-yearly thereafter depending on risk factors. Ultrasound can identify steatosis but doesn’t adequately identify the fibrosis associated with severe disease.

Improvements in weight, diet, physical activity, insulin resistance and obstructive sleep apnoea all improve biomarkers and disease severity. Optimising vitamin D may minimise fibrosis [ 30 ]. There is insufficient evidence to recommend any one dietary approach, with limited benefit seen with low fructose, low fat and low glycaemic index diets [ 29 , 70 , 71 , 72 , 73 ]. Psychological support (as part of multidisciplinary management) may help to improve clinical outcomes [ 74 ].

There is currently no specific pharmacological treatment for paediatric NAFLD. Metformin, vitamin E, antioxidants, fatty acid supplements and probiotics show no clear benefit on histologic outcomes or sustained reduction in ALT in CYP. In adults, pioglitazone has been recommended for advanced liver fibrosis [ 33 , 34 , 35 , 36 , 75 , 76 , 77 , 78 , 79 , 80 ].

Retinopathy

Diabetic retinopathy (DR) is a major cause of visual loss in working age adults and increases the risk of cataracts and glaucoma [ 37 , 81 , 82 ]. It is mainly associated with long-duration diabetes [ 83 , 84 , 85 ]. TODAY study showed that high HbA1c was associated with an increased risk of developing retinopathy regardless of disease duration [ 86 ].

At 20 years post diagnosis nearly all UK adults with type 1 diabetes and 60% of adults with type 2 diabetes have some degree of retinopathy [ 87 ].

Severe disease is unlikely before 12 years [ 37 , 88 ] and UK guidelines recommend screening from this age regardless of disease duration.

Albuminuria and chronic kidney disease

Kidney disease is an important complication of diabetes and is one of the most common causes of chronic kidney disease (CKD). It is characterised by persistently raised albuminuria beyond 3 months with a low estimated glomerular filtration rate (eGFR) [ 89 ].

Albuminuria is strongly associated with the progression of CKD and cardiovascular morbidity and mortality [ 90 , 91 , 92 , 93 ]. Albuminuria occurs more commonly in type 2 than type 1 diabetes and is likely independent of differences in body mass index and hypertension [ 2 ].

A random urine sample is the preferred outpatient screening and correlates with 24-h collection [ 94 , 95 ]. Micral (dipstick) is the easiest and most cost-effective screening test [ 96 ]. An early morning sample should be tested where random urine albumin creatinine ratio (ACR) is > 3 mg/mmol [ 97 ] to minimise false-positive results due to hyperglycaemia, exercise, smoking, menstruation, recent intercourse or sample contamination [ 46 ]. Urine ACR should be raised on two of three consecutive tests obtained on different days within a 3- to 6-month period before the diagnosis is confirmed [ 46 ].

The severity of the disease should be characterised using increased ACR (3–30 mg/mmol) and severely increased ACR (> 30 mg/mmol) rather than the terms microalbuminuria and macroalbuminuria [ 98 ].

Other causes of CKD should be considered, especially if there is reduced eGRF without albuminuria or the presence of both retinopathy and albuminuria > 30 mg/mmol creatinine.

Improved blood glucose and blood pressure prevent and slow the progression of nephropathy. Therapeutic options include the use of angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (see the “Hypertension” section) [ 31 , 32 , 46 , 99 , 100 ].

We recommend referral to specialist renal/kidney care services where GFR < 30 ml/min/1.73 m 2 , consistent significant albuminuria > 30 mg/mmol, and significant haematuria or structural abnormalities are detected on ultrasound (1B) [ 46 , 89 ].

Obstructive sleep apnoea (OSA)

Obstructive sleep apnoea (OSA) is a sleep disorder characterized by repetitive episodes of upper-airway obstruction which result in intermittent hypoxemia and transient arousals leading to sleep fragmentation and poor sleep quality. Sleep disturbance and OSA are increasingly recognised as being associated with obesity, insulin resistance in adults and children and type 2 diabetes in adults. Additionally, it is a risk factor for future cardiovascular disease [ 101 , 102 , 103 , 104 , 105 , 106 , 107 ].

Obesity, male sex, and advancing age are the strongest risk factors for OSA [ 108 , 109 ]. It affects an estimated 1–2% of normal children [ 110 , 111 ] and is more common in obese youth [ 45 ].

Evaluate symptoms of obstructive sleep apnoea using questions about snoring, apnoea, nocturia, enuresis, sleep quality, morning headaches and daytime sleepiness at every visit after diagnosis [ 45 , 112 ]. Questionnaires alone do not provide a high enough sensitivity or specificity and clinicians should have a high index of suspicion [ 113 , 114 ].

The gold standard diagnostic test is overnight laboratory polysomnography, which quantifies episodes of apnoea and hypopnoea, with an apnoea–hypopnoea index (AHI) of > 5 being diagnostic [ 103 ]. Treatment with continuous airway pressure has been associated with improvement in the glycaemic profile, HbA1c, insulin sensitivity and inflammation in some studies [ 115 , 116 , 117 , 118 , 119 ].

This guideline is the first national guideline on managing type 2 diabetes in children and young people. It gives practical advice on managing this challenging and aggressive condition. Paediatricians do not have extensive experience in managing type 2 diabetes due to a limited number of patients so can struggle with confidence in managing these patients. The authors hope that this guideline will provide paediatricians with the necessary information about managing type 2 diabetes and associated complications.

Availability of data and materials

This document is based on an evidence-based guideline. A literature search was conducted on all relevant topics and the paper summarises the main recommendations from A practical approach to Management of type 2 diabetes in CYP under18 years.

Abbreviations

Association of British Clinical Diabetologists

Association of Children’s Diabetes Clinicians

Angiotensin-converting enzyme

Albumin creatinine ratio

Apnoea–hypopnoea index

Alanine transaminase

Body mass index

British Society of Paediatric Endocrinology and Diabetes

Continuous glucose monitoring

Creatine kinase

Chronic kidney disease

Cardiovascular disease

• Children and young people

Diabetic ketoacidosis

Dipeptidyl peptidase

Diabetic retinopathy

Estimated glomerular filtration rate

Flash glucose monitoring

Grading Of Recommendations, Assessment, Development and Evaluation

High-density lipoproteins-cholesterol

Low-density lipoprotein

Liver function tests

Major cardiovascular event

Multidisciplinary team sodium-glucose cotransporter-2

Medicines and health products regulatory agency

Non-alcoholic fatty liver disease

Non-alcoholic steatohepatitis

Obstructive sleep apnoea

Paediatric quality of life

Polycystic ovary syndrome

Quality of life

Sodium-glucose cotransporter-2

Self-monitoring of blood glucose

Type 2 diabetes mellitus

TODAY Standard Education Diabetes Education

Viner R, White B, Christie D. Type 2 diabetes in adolescents: a severe phenotype posing major clinical challenges and public health burden. Lancet. 2017;389(10085):2252–60.

Article   PubMed   Google Scholar  

Jensen ET, Dabelea D. Type 2 Diabetes in Youth: New Lessons from the SEARCH Study. Curr Diab Rep. 2018;18(6):36.

Article   PubMed   PubMed Central   Google Scholar  

TODAY Study Group; Zeitler P, Hirst K, Pyle L, Linder B, Copeland K, Arslanian S, Cuttler L, Nathan DM, Tollefsen S, Wilfley D, Kaufman F. A clinical trial to maintain glycemic control in youth with type 2 diabetes. N Engl J Med. 2012;366(24):2247–56. https://doi.org/10.1056/NEJMoa1109333 .

Walders-Abramson N. Depression and quality of life in youth-onset type 2 diabetes mellitus. Curr Diab Rep. 2014;14(1):449.

Hilliard ME, Powell PW, Anderson BJ. Evidence-based behavioral interventions to promote diabetes management in children, adolescents, and families. Am Psychol. 2016;71(7):590–601.

Pinhas-Hamiel O, Dolan LM, Zeitler PS. Diabetic ketoacidosis among obese African-American adolescents with NIDDM. Dia Care. 1997;20(4):484–6.

Article   CAS   Google Scholar  

Schwartz S, Fonseca V, Berner B, Cramer M, Chiang YK, Lewin A. Efficacy, tolerability, and safety of a novel once-daily extended-release metformin in patients with type 2 diabetes. Dia Care. 2006;29(4):759–64.

Laffel L, Chang N, Grey M, Hale D, Higgins L, Hirst K, et al. Metformin monotherapy in youth with recent onset type 2 diabetes: experience from the prerandomization run-in phase of the TODAY study. Pediatr Diabetes. 2012;13(5):369–75.

Article   CAS   PubMed   Google Scholar  

Kelsey MM, Geffner ME, Guandalini C, Pyle L, Tamborlane WV, Zeitler PS, et al. Presentation and effectiveness of early treatment of type 2 diabetes in youth: lessons from the TODAY study. Pediatr Diabetes. 2016;17(3):212–21.

RISE Consortium. Impact of insulin and metformin versus metformin alone on β-cell function in youth with impaired glucose tolerance or recently diagnosed type 2 diabetes. Diabetes Care. 2018;41(8):1717–25. https://doi.org/10.2337/dc18-0787 .

TODAY Study Group. Safety and tolerability of the treatment of youth-onset type 2 diabetes: the TODAY experience. Diabetes Care. 2013;36(6):1765–71. https://doi.org/10.2337/dc12-2390 .

Levitt Katz LE, Bacha F, Gidding SS, Weinstock RS, El Ghormli L, Libman I, et al. Lipid profiles, inflammatory markers, and insulin therapy in youth with type 2 diabetes. J Pediatr. 2018;196:208-16.e2.

Laffel LMB, Tamborlane WV, Yver A, Simons G, Wu J, Nock V, et al. Pharmacokinetic and pharmacodynamic profile of the sodium-glucose co-transporter-2 inhibitor empagliflozin in young people with Type 2 diabetes: a randomized trial. Diabet Med. 2018;35(8):1096–104.

Article   CAS   PubMed   PubMed Central   Google Scholar  

Tamborlane WV, Polidori D, Argenti D, Di Prospero NA. Pharmacokinetics and pharmacodynamics of canagliflozin in pediatric patients with type 2 diabetes. Pediatr Diabetes. 2018;19(4):649–55.

Tirucherai GS, LaCreta F, Ismat FA, Tang W, Boulton DW. Pharmacokinetics and pharmacodynamics of dapagliflozin in children and adolescents with type 2 diabetes mellitus. Diabetes Obes Metab. 2016;18(7):678–84.

Parkinson J, Tang W, Johansson CC, Boulton DW, Hamrén B. Comparison of the exposure-response relationship of dapagliflozin in adult and paediatric patients with type 2 diabetes mellitus. Diabetes Obes Metab. 2016;18(7):685–92.

Inge TH, Laffel LM, Jenkins TM, Marcus MD, Leibel NI, Brandt ML, et al. Comparison of surgical and medical therapy for type 2 diabetes in severely obese adolescents. JAMA Pediatr. 2018;172(5):452–60.

Ruiz-Cota P, Bacardí-Gascón M, Jiménez-Cruz A. Long-term outcomes of metabolic and bariatric surgery in adolescents with severe obesity with a follow-up of at least 5 years: a systematic review. Surg Obes Relat Dis. 2019;15(1):133–44.

Inge TH, Courcoulas AP, Jenkins TM, Michalsky MP, Brandt ML, Xanthakos SA, et al. Five-year outcomes of gastric bypass in adolescents as compared with adults. N Engl J Med. 2019;380(22):2136–45.

Johansson K, Cnattingius S, Näslund I, Roos N, Trolle Lagerros Y, Granath F, et al. Outcomes of pregnancy after bariatric surgery. N Engl J Med. 2015;372(9):814–24.

Kwong W, Tomlinson G, Feig DS. Maternal and neonatal outcomes after bariatric surgery; a systematic review and meta-analysis: do the benefits outweigh the risks? Am J Obstet Gynecol. 2018;218(6):573–80.

Blood pressure charts.  https://www.nhlbi.nih.gov/files/docs/guidelines/child_tbl.pdf .

Flynn JT, Kaelber DC, Baker-Smith CM, Blowey D, Carroll AE, Daniels SR, de Ferranti SD, Dionne JM, Falkner B, Flinn SK, Gidding SS, Goodwin C, Leu MG, Powers ME, Rea C, Samuels J, Simasek M, Thaker VV, Urbina EM. Subcommittee on screening and management of high blood pressure in children. Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents. Pediatrics. 2017;140(3):e20171904. https://doi.org/10.1542/peds.2017-1904 . Erratum in: Pediatrics. 2017. Erratum in: Pediatrics. 2018;142(3). PMID: 28827377.

Byrne CD, Targher G. NAFLD: a multisystem disease. J Hepatol. 2015;62(1 Suppl):S47-64.

Goyal NP, Schwimmer JB. The progression and natural history of pediatric nonalcoholic fatty liver disease. Clin Liver Dis. 2016;20(2):325–38.

Schwimmer JB, Behling C, Newbury R, Deutsch R, Nievergelt C, Schork NJ, et al. Histopathology of pediatric nonalcoholic fatty liver disease. Hepatology (Baltimore, MD). 2005;42(3):641–9.

Newton KP, Hou J, Crimmins NA, Lavine JE, Barlow SE, Xanthakos SA, et al. Prevalence of prediabetes and type 2 diabetes in children with nonalcoholic fatty liver disease. JAMA Pediatr. 2016;170(10):e161971.

Vajro P, Lenta S, Socha P, Dhawan A, McKiernan P, Baumann U, et al. Diagnosis of nonalcoholic fatty liver disease in children and adolescents: position paper of the ESPGHAN Hepatology Committee. J Pediatr Gastroenterol Nutr. 2012;54(5):700–13.

Schwimmer JB, Ugalde-Nicalo P, Welsh JA, Angeles JE, Cordero M, Harlow KE, et al. Effect of a low free sugar diet vs usual diet on nonalcoholic fatty liver disease in adolescent boys: a randomized clinical trial. JAMA. 2019;321(3):256–65.

Yodoshi T, Orkin S, Arce-Clachar AC, Bramlage K, Liu C, Fei L, et al. Vitamin D deficiency: prevalence and association with liver disease severity in pediatric nonalcoholic fatty liver disease. Eur J Clin Nutr. 2020;74(3):427–35.

Bjornstad P, Cherney DZ, Maahs DM, Nadeau KJ. Diabetic kidney disease in adolescents with type 2 diabetes: new insights and potential therapies. Curr Diab Rep. 2016;16(2):11.

Effects of ramipril on cardiovascular and microvascular outcomes in people with diabetes mellitus: results of the HOPE study and MICRO HOPE substudy. Heart Outcomes Prevention Evaluation Study Investigators. Lancet. 2000;355(9200):253–9. Erratum in: Lancet 2000 Sep 2;356(9232):860. PMID: 10675071.

Nobili V, Alisi A, Mosca A, Crudele A, Zaffina S, Denaro M, et al. The antioxidant effects of hydroxytyrosol and vitamin E on pediatric nonalcoholic fatty liver disease, in a clinical trial: a new treatment? Antioxid Redox Signal. 2019;31(2):127–33.

Nobili V, Alisi A, Musso G, Scorletti E, Calder PC, Byrne CD. Omega-3 fatty acids: Mechanisms of benefit and therapeutic effects in pediatric and adult NAFLD. Crit Rev Clin Lab Sci. 2016;53(2):106–20.

Scorletti E, Byrne CD. Omega-3 fatty acids and non-alcoholic fatty liver disease: Evidence of efficacy and mechanism of action. Mol Aspects Med. 2018;64:135–46.

Nobili V, Putignani L, Mosca A, Del Chierico F, Vernocchi P, Alisi A, et al. Bifidobacteria and lactobacilli in the gut microbiome of children with non-alcoholic fatty liver disease: which strains act as health players? Arch Med Sci. 2018;14(1):81–7.

Hamid A, Wharton HM, Mills A, Gibson JM, Clarke M, Dodson PM. Diagnosis of retinopathy in children younger than 12 years of age: implications for the diabetic eye screening guidelines in the UK. Eye (Lond). 2016;30(7):949–51.

Waugh NR, Shyangdan D, Taylor-Phillips S, Suri G, Hall B. Screening for type 2 diabetes: a short report for the National Screening Committee. Health Technol Assess. 2013;17(35):1–90.

Who WHO. Use of Glycated Haemoglobin (HbA1c) in the diagnosis of diabetes mellitus. World Health Organistaion, WHO/NMH/CHP/CPM/11.1.  https://www.who.int/publications-detail-redirect/use-of-glycated-haemoglobin-(-hba1c)-in-diagnosis-of-diabetesmellitus .

King P, Peacock I, Donnelly R. The UK Prospective Diabetes Study (UKPDS): clinical and therapeutic implications for type 2 diabetes. Br J Clin Pharmacol. 1999;48(5):643–8.

UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. UK Prospective Diabetes Study Group. BMJ. 1998;317(7160):703-13. Erratum in: BMJ 1999;318(7175):29. PMID: 9732337; PMCID: PMC28659.

Zeitler P, Hirst K, Copeland KC, El Ghormli L, Levitt Katz L, Levitsky LL, et al. HbA _1c After a Short Period of Monotherapy With Metformin Identifies Durable Glycemic Control Among Adolescents With Type 2 Diabetes. Dia Care. 2015;38(12):2285–92.

Weinstock RS, Braffett BH, McGuigan P, Larkin ME, Grover NB, Walders-Abramson N, et al. Self-monitoring of blood glucose in youth-onset type 2 diabetes: results from the TODAY study. Dia Care. 2019;42(5):903–9.

Badaru A, Klingensmith GJ, Dabelea D, Mayer-Davis EJ, Dolan L, Lawrence JM, et al. Correlates of treatment patterns among youth with type 2 diabetes. Dia Care. 2014;37(1):64–72.

Article   Google Scholar  

Zeitler P, Arslanian S, Fu J, Pinhas-Hamiel O, Reinehr T, Tandon N, et al. ISPAD clinical practice consensus guidelines 2018: type 2 diabetes mellitus in youth. Pediatr Diabetes. 2018;19(Suppl 27):28–46.

Arslanian S, Bacha F, Grey M, Marcus MD, White NH, Zeitler P. Evaluation and management of youth-onset type 2 diabetes: a position statement by the American Diabetes Association. Dia Care. 2018;41(12):2648–68.

Nice. Diabetes (type 1 and type 2) in children and young people: diagnosis and management | Guidance | NICE. National Institute of Health and Care Excellence, 2018 2018. Report No.: NG18.  https://www.nice.org.uk/guidance/ng18 .

Beck RW, Connor CG, Mullen DM, Wesley DM, Bergenstal RM. The fallacy of average: how using HbA(1c) alone to assess glycemic control can be misleading. Dia Care. 2017;40(8):994–9.

New JP, Ajjan R, Pfeiffer AF, Freckmann G. Continuous glucose monitoring in people with diabetes: the randomized controlled Glucose Level Awareness in Diabetes Study (GLADIS). Diabetic Med. 2015;32(5):609–17.

Couch R, Jetha M, Dryden DM, Hooten N, Liang Y, Durec T, et al. Diabetes education for children with type 1 diabetes mellitus and their families. Evid Rep Technol Assess (Full Rep). 2008;166:1–144.

Google Scholar  

Perrin N, Bodicoat DH, Davies MJ, Robertson N, Snoek FJ, Khunti K. Effectiveness of psychoeducational interventions for the treatment of diabetes-specific emotional distress and glycaemic control in people with type 2 diabetes: a systematic review and meta-analysis. Prim Care Diabetes. 2019;13(6):556–67.

Grey M, Schreiner B, Pyle L. Development of a diabetes education program for youth with type 2 diabetes. Diabetes Educ. 2009;35(1):108–16.

Troughton J, Schreder S, Hadjiconstantinou M, Jarvis J, Northern A, Franklin C, et al. editors. Developing an education programme for children with Type 2 diabetes: iCAN live well with diabetes. Diabetes UK Professional Conference 2019. ACC Liverpool: DiabetesUK.

Haigh K, McDermott R, Sinha A, McLean A. Diagnosis and management of type 2 diabetes in youth in North Queensland and the Northern Territory: a health professional survey. Aust J Rural Health. 2019;27(1):42–8.

Ritholz MD, Beverly EA, Abrahamson MJ, Brooks KM, Hultgren BA, Weinger K. Physicians’ perceptions of the type 2 diabetes multidisciplinary treatment team: a qualitative study. Diabetes Educ. 2011;37(6):794–800.

American Diabetes A. 8. Obesity management for the treatment of type 2 diabetes: standards of medical care in diabetes—2021. Dia Care. 2021;44(Supplement 1):S100–10.

Franz MJ, Boucher JL, Rutten-Ramos S, VanWormer JJ. Lifestyle weight-loss intervention outcomes in overweight and obese adults with type 2 diabetes: a systematic review and meta-analysis of randomized clinical trials. J Acad Nutr Diet. 2015;115(9):1447–63.

Lean MEJ, Leslie WS, Barnes AC, Brosnahan N, Thom G, McCombie L, et al. Durability of a primary care-led weight-management intervention for remission of type 2 diabetes: 2-year results of the DiRECT open-label, cluster-randomised trial. Lancet Diabetes Endocrinol. 2019;7(5):344–55.

Marcus MD, Wilfley DE, Ghormli LE, Zeitler P, Linder B, Hirst K, et al. Weight change in the management of youth-onset type 2 diabetes: the TODAY clinical trial experience. Pediatr Obes. 2017;12(4):337–45.

Yang D, Yang Y, Li Y, Han R. Physical exercise as therapy for type 2 diabetes mellitus: from mechanism to orientation. ANM. 2019;74(4):313–21.

CAS   Google Scholar  

Johnson ST, Newton AS, Chopra M, Buckingham J, Huang TTK, Franks PW, et al. In search of quality evidence for lifestyle management and glycemic control in children and adolescents with type 2 diabetes: a systematic review. BMC Pediatr. 2010;10(1):97.

Chadwick JQ, Van Buren DJ, Morales E, Timpson A, Abrams EL, Syme A, et al. Structure to utilize interventionists’ implementation experiences of a family-based behavioral weight management program to enhance the dissemination of the standardized intervention: the TODAY study. Clin Trials (London, England). 2017;14(4):406–12.

Rockette-Wagner B, Storti KL, Edelstein S, Delahanty LM, Galvin B, Jackson A, et al. Measuring physical activity and sedentary behavior in youth with type 2 diabetes. Child Obes. 2017;13(1):72–7.

Guillory IK, Cullen KW, Thompson D, Watson KB. Physical activity in youth with well-controlled versus poorly controlled type 2 diabetes. Clin Pediatr (Phila). 2012;51(4):354–8.

Physical activity guidelines for children and young people 2021. Available from: https://www.nhs.uk/live-well/exercise/exercise-guidelines/physical-activity-guidelines-children-and-young-people/ .

Lawrence JM, Standiford DA, Loots B, Klingensmith GJ, Williams DE, Ruggiero A, et al. Prevalence and correlates of depressed mood among youth with diabetes: the SEARCH for diabetes in youth study. Pediatrics. 2006;117(4):1348–58.

Nip ASY, Reboussin BA, Dabelea D, Bellatorre A, Mayer-Davis EJ, Kahkoska AR, et al. Disordered eating behaviors in youth and young adults with type 1 or type 2 diabetes receiving insulin therapy: the SEARCH for diabetes in youth study. Dia Care. 2019;42(5):859–66.

Copeland KC, Zeitler P, Geffner M, Guandalini C, Higgins J, Hirst K, et al. Characteristics of adolescents and youth with recent-onset type 2 diabetes: the TODAY cohort at baseline. J Clin Endocrinol Metab. 2011;96(1):159–67.

Varni JW, Delamater AM, Hood KK, Raymond JK, Chang NT, Driscoll KA, et al. Pediatric Quality of Life Inventory (PedsQL) 3.2 diabetes module for youth with type 2 diabetes: reliability and validity. Diabet Med. 2019;36(4):465–72.

Mann JP, Tang GY, Nobili V, Armstrong MJ. Evaluations of lifestyle, dietary, and pharmacologic treatments for pediatric nonalcoholic fatty liver disease: a systematic review. Clin Gastroenterol Hepatol. 2019;17(8):1457-76.e7.

Labayen I, Medrano M. Effects of exercise in addition to a family-based lifestyle intervention program on hepatic fat in children with overweight. Diabetes Care. 2020;43(2):306–13.

Gibson PS, Lang S, Dhawan A, Fitzpatrick E, Blumfield ML, Truby H, et al. Systematic review: nutrition and physical activity in the management of paediatric nonalcoholic fatty liver disease. J Pediatr Gastroenterol Nutr. 2017;65(2):141–9.

Sundaram SS, Halbower AC, Klawitter J, Pan Z, Robbins K, Capocelli KE, et al. Treating obstructive sleep apnea and chronic intermittent hypoxia improves the severity of nonalcoholic fatty liver disease in children. J Pediatr. 2018;198:67-75.e1.

Karaivazoglou K, Kalogeropoulou M, Assimakopoulos S, Triantos C. Psychosocial issues in pediatric nonalcoholic fatty liver disease. Psychosomatics. 2019;60(1):10–7.

Lavine JE, Schwimmer JB, Van Natta ML, Molleston JP, Murray KF, Rosenthal P, et al. Effect of vitamin E or metformin for treatment of nonalcoholic fatty liver disease in children and adolescents: the TONIC randomized controlled trial. JAMA. 2011;305(16):1659–68.

McDonagh MS, Selph S, Ozpinar A, Foley C. Systematic review of the benefits and risks of metformin in treating obesity in children aged 18 years and younger. JAMA Pediatr. 2014;168(2):178–84.

Amanullah I, Khan YH. Effect of vitamin E in non-alcoholic fatty liver disease: a systematic review and meta-analysis of randomised controlled trials. Postgrad Med J. 2019;95(1129):601–11.

National Guideline C. National Institute for Health and Care Excellence: Guidance. Non-Alcoholic Fatty Liver Disease: Assessment and Management. London: National Institute for Health and Care Excellence (UK) Copyright © National Institute for Health and Care Excellence 2016; 2016.

Schwimmer JB, Behling C, Angeles JE, Paiz M, Durelle J, Africa J, et al. Magnetic resonance elastography measured shear stiffness as a biomarker of fibrosis in pediatric nonalcoholic fatty liver disease. Hepatology (Baltimore, MD). 2017;66(5):1474–85.

Schwimmer JB, Lavine JE, Wilson LA, Neuschwander-Tetri BA, Xanthakos SA, Kohli R, et al. In children with nonalcoholic fatty liver disease, cysteamine bitartrate delayed release improves liver enzymes but does not reduce disease activity scores. Gastroenterology. 2016;151(6):1141-54.e9.

Diabetes and eye prolems (Diabetic retinpathy) 2015. Available from: https://www.diabetes.org.uk/guide-to-diabetes/complications/retinopathy . Cited 2020 January.

Mathur R, Bhaskaran K, Edwards E, Lee H, Chaturvedi N, Smeeth L, et al. Population trends in the 10-year incidence and prevalence of diabetic retinopathy in the UK: a cohort study in the Clinical Practice Research Datalink 2004–2014. BMJ Open. 2017;7(2):e014444.

Joner G, Brinchmann-Hansen O, Torres CG, Hanssen KE. A nationwide cross-sectional study of retinopathy and microalbuminuria in young Norwegian Type 1 (insulin-dependent) diabetic patients. Diabetologia. 1992;35(11):1049–54.

Lueder GT, Pradhan S, White NH. Risk of retinopathy in children with type 1 diabetes mellitus before 2 years of age. Am J Ophthalmol. 2005;140(5):930–1.

Health Intelligence Improving diabetes healthcare, Diabetic eye screening. Available at: www.diabetes.org.uk .

TODAY Study Group. Retinopathy in youth with type 2 diabetes participating in the TODAY clinical trial. Diabetes Care. 2013;36(6):1772–4. https://doi.org/10.2337/dc12-2387 .

Diabetes UK, facts and stats 2019. Available from: https://www.diabetes.org.uk/resources-s3/2019-02/1362B_Facts%20and%20stats%20Update%20Jan%202019_LOW%20RES_EXTERNAL.pdf . Cited 2020 January.

Scanlon PH, Stratton IM, Bachmann MO, Jones C, Leese GP. Risk of diabetic retinopathy at first screen in children at 12 and 13 years of age. Diabet Med. 2016;33(12):1655–8.

Levin A, Stevens PE, Bilous RW, Coresh J, De Francisco ALM, De Jong PE, Griffith KE, Hemmelgarn BR, Iseki K, Lamb EJ, Levey AS, Riella MC, Shlipak MG, Wang H, White CT, Winearls CG. Kidney disease: Improving global outcomes (KDIGO) CKD work group. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl. 2012;2013(3):1–150.

Fox CS, Matsushita K, Woodward M, Bilo HJ, Chalmers J, Heerspink HJ, et al. Associations of kidney disease measures with mortality and end-stage renal disease in individuals with and without diabetes: a meta-analysis. Lancet. 2012;380(9854):1662–73.

KDOQI. KDOQI clinical practice guidelines and clinical practice recommendations for diabetes and chronic kidney disease. Am J Kidney Dis. 2007;49(2 Suppl 2):S12–154. https://doi.org/10.1053/j.ajkd.2006.12.005 .

Adler AI, Stevens RJ, Manley SE, Bilous RW, Cull CA, Holman RR. Development and progression of nephropathy in type 2 diabetes: the United Kingdom Prospective Diabetes Study (UKPDS 64). Kidney Int. 2003;63(1):225–32.

Maahs DM, Snively BM, Bell RA, Dolan L, Hirsch I, Imperatore G, et al. Higher prevalence of elevated albumin excretion in youth with type 2 than type 1 diabetes: the SEARCH for Diabetes in Youth study. Dia Care. 2007;30(10):2593–8.

Zelmanovitz T, Gross JL, Oliveira JR, Paggi A, Tatsch M, Azevedo MJ. The receiver operating characteristics curve in the evaluation of a random urine specimen as a screening test for diabetic nephropathy. Dia Care. 1997;20(4):516–9.

Nathan DM, Genuth S, Lachin J, Cleary P, Crofford O, Davis M, et al. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993;329(14):977–86.

Lepore G, Maglio ML, Nosari I, Dodesini AR, Trevisan R. Cost-effectiveness of two screening programs for microalbuminuria in type 2 diabetes. Dia Care. 2002;25(11):2103–4. author reply 4.

Stevens PE, Levin A. Evaluation and management of chronic kidney disease: synopsis of the kidney disease: improving global outcomes 2012 clinical practice guideline. Ann Intern Med. 2013;158(11):825–30.

Tuttle KR, Bakris GL, Bilous RW, Chiang JL, de Boer IH, Goldstein-Fuchs J, et al. Diabetic kidney disease: a report from an ADA consensus conference. Dia Care. 2014;37(10):2864–83.

Ruggenenti P, Fassi A, Ilieva AP, Bruno S, Iliev IP, Brusegan V, et al. Preventing microalbuminuria in type 2 diabetes. N Engl J Med. 2004;351(19):1941–51.

Marcovecchio ML, Chiesa ST, Bond S, Daneman D, Dawson S, Donaghue KC, et al. ACE inhibitors and statins in adolescents with type 1 diabetes. N Engl J Med. 2017;377(18):1733–45.

Cappuccio FP, Taggart FM, Kandala NB, Currie A, Peile E, Stranges S, et al. Meta-analysis of short sleep duration and obesity in children and adults. Sleep. 2008;31(5):619–26.

Broussard JL, Van Cauter E. Disturbances of sleep and circadian rhythms: novel risk factors for obesity. Curr Opin Endocrinol Diabetes Obes. 2016;23(5):353–9.

Reutrakul S, Van Cauter E. Interactions between sleep, circadian function, and glucose metabolism: implications for risk and severity of diabetes. Ann N Y Acad Sci. 2014;1311:151–73.

Chen X, Beydoun MA, Wang Y. Is sleep duration associated with childhood obesity? A systematic review and meta-analysis. Obesity (Silver Spring, Md). 2008;16(2):265–74.

Koren D, Levitt Katz LE, Brar PC, Gallagher PR, Berkowitz RI, Brooks LJ. Sleep architecture and glucose and insulin homeostasis in obese adolescents. Dia Care. 2011;34(11):2442–7.

Tasali E, Leproult R, Ehrmann DA, Van Cauter E. Slow-wave sleep and the risk of type 2 diabetes in humans. Proc Natl Acad Sci USA. 2008;105(3):1044–9.

Jean-Louis G, Zizi F, Clark LT, Brown CD, McFarlane SI. Obstructive sleep apnea and cardiovascular disease: role of the metabolic syndrome and its components. J Clin Sleep Med. 2008;4(3):261–72.

Pamidi S, Wroblewski K, Broussard J, Day A, Hanlon EC, Abraham V, et al. Obstructive sleep apnea in young lean men: impact on insulin sensitivity and secretion. Diabetes Care. 2012;35(11):2384–9.

Meir Kryger TR, William Dement. Anatomy and physiology of upper airway obstruction. principles and Practice of sleep medicine. 4th ed: Kryger; 18th March 2005. p. 983–1000.

Nixon GM, Brouillette RT. Sleep. 8: paediatric obstructive sleep apnoea. Thorax. 2005;60(6):511–6.

Brunetti L, Rana S, Lospalluti ML, Pietrafesa A, Francavilla R, Fanelli M, et al. Prevalence of obstructive sleep apnea syndrome in a cohort of 1,207 children of southern Italy. Chest. 2001;120(6):1930–5.

Peña AS, Curran JA, Fuery M, George C, Jefferies CA, Lobley K, et al. Screening, assessment and management of type 2 diabetes mellitus in children and adolescents: Australasian Paediatric Endocrine Group guidelines. Med J Aust. 2020;213(1):30–43.

Westlake K, Polak J. Screening for obstructive sleep apnea in type 2 diabetes patients - questionnaires are not good enough. Front Endocrinol. 2016;7:124.

El-Sayed IH. Comparison of four sleep questionnaires for screening obstructive sleep apnea. Egypt J Chest Dis Tuberc. 2012;61(4):433–41.

Mokhlesi B, Grimaldi D, Beccuti G, Abraham V, Whitmore H, Delebecque F, et al. Effect of one week of 8-hour nightly continuous positive airway pressure treatment of obstructive sleep apnea on glycemic control in type 2 diabetes: a proof-of-concept study. Am J Respir Crit Care Med. 2016;194(4):516–9.

Martínez-Cerón E, Barquiel B, Bezos AM, Casitas R, Galera R, García-Benito C, et al. Effect of continuous positive airway pressure on glycemic control in patients with obstructive sleep apnea and type 2 diabetes. A randomized clinical trial. Am J Respir Crit Care Med. 2016;194(4):476–85.

Zychowski KE, Sanchez B, Pedrosa RP, Lorenzi-Filho G, Drager LF, Polotsky VY, et al. Serum from obstructive sleep apnea patients induces inflammatory responses in coronary artery endothelial cells. Atherosclerosis. 2016;254:59–66.

Katz SL, MacLean JE, Hoey L, Horwood L, Barrowman N, Foster B, et al. Insulin resistance and hypertension in obese youth with sleep-disordered breathing treated with positive airway pressure: a prospective multicenter study. J Clin Sleep Med. 2017;13(9):1039–47.

Feng Y, Zhang Z, Dong ZZ. Effects of continuous positive airway pressure therapy on glycaemic control, insulin sensitivity and body mass index in patients with obstructive sleep apnoea and type 2 diabetes: a systematic review and meta-analysis. NPJ Prim Care Respir Med. 2015;25:15005.

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Acknowledgements

Authors thank the ACDC guideline development group and National Type 2 working group for their contribution to the development of a clinical guideline for the management of type 2 diabetes in CYP under18 years.

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Patient information leaflet

Sglt2 inhibitors and diabetic ketoacidosis in type-2 diabetes.

Why have I been given this leaflet?

You are taking, or about to take, one of the following drugs for improving your diabetes management:

Empagliflozin (Jardiance)

Canagliflozin (Invokana)

Dapagliflozin (Forxiga)

What do I need to know about these drugs?

These medications have been given to you to help you improve your weight and your blood glucose levels. However, people taking this drug can develop an unusual complication of diabetes, called euglycaemic diabetic ketoacidosis. This happens when too much acid builds up in the blood and can happen even when your blood glucose level is normal. If not identified early, this can be dangerous. However, this is a VERY RARE complication.

What should I look out for?

If you are taking one of these tablets, please look out for these symptoms:

Nausea and/or vomiting,

Fast breathing,

Abdominal pains,

Unusual drowsiness or

If you have any of these symptoms, please measure your blood ketones, if you have a blood ketone meter at home. If your levels are over 0.6 mmol/L, please contact your diabetes team immediately, even if your blood glucose is near normal. If you cannot get hold of your diabetes team, please call NHS Direct at 111 for more advice. Inform them that you are worried about “Diabetic keto-acid-osis”.

If you do not have a blood ketone meter at home, please contact your diabetes team or 111, as above.

Stop your medication till further medical advice

What can cause this problem?

This problem can develop at any time. You need to be especially careful:

if you develop an infection (like a chest or urine infection) or undergo surgery.

If you are planning to have an operation or any other procedure which involves fasting overnight, please discuss this medication with your doctor or nurse – you may need to stop your tablets.

If I feel unwell, what will my doctor or nurse do?

You will have a finger prick blood test to test for the amount of glucose and ketones (a breakdown product of fat) in the blood. If the levels of ketones are high, you may need to attend the hospital to be treated. In the meantime, please ensure you are keeping yourself well-hydrated. Please continue to take your insulin, if you usually take insulin.

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White, B., Ng, S.M., Agwu, J.C. et al. A practical evidence-based approach to management of type 2 diabetes in children and young people (CYP): UK consensus. BMC Med 22 , 144 (2024). https://doi.org/10.1186/s12916-024-03349-4

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DOI : https://doi.org/10.1186/s12916-024-03349-4

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