Improving the long-term outlook for children with diabetes mellitus

Altogether 29,000 children and young people have diabetes in the UK today and the incidence is rising at a rate of 3% per year. Despite clear evidence showing that poor glycaemic control increases the risk of long-term complications only 15.8% of children and young people in England and Wales have an HbA1c within target range. Potential complications include growth and endocrine disorders, acute problems such as diabetic ketoacidosis and hypoglycaemia as well as future microvascular and macrovascular disease. This article reviews these complications together with long-term survival associated with childhood diabetes describing how the outlook for these children and young people can be improved both by optimizing glycaemic control and by screening and prompt treatment of complications. Finally, possible future therapeutic options including the “artificial pancreas”, islet cell transplantation and stem cell technology are reviewed.