Clinical services for children with diabetes

Diabetes mellitus is one of the most common long-term conditions in childhood. The management of children and young people is predominantly carried out by general paediatricians with a special interest in diabetes, together with paediatric diabetes specialist nurses and dieticians. Various guidelines and recommendations have been published with the aim of improving standards and quality of care; however, surveys conducted in the United Kingdom at periodic intervals have regularly shown deficiencies in the provision of care for these children and young people. With intensification of insulin regimens, education of the child and family is the cornerstone of management with a view to enabling self-care. Targets of each service should be to improve glycaemic control and thereby to prevent complications. Psychological support, social services, counselling, ophthalmology, and podiatry should be available. To ensure that care is of the highest standard, the team should have access to good clinic and hospital facilities and adequate manpower. Services should be commissioned accordingly to meet the demands of the local population. Regional networks form an important forum to discuss case load, sharing of resources, training for consistency in the region, and collection of outcome data with contribution to national audit.