Diabetes in the young: past, present and future

Optimal management of diabetes in children and adolescents continues to present difficult challenges. Constant and unpredictable changes in growth, development and physiological maturity are compounded by problems of brittle families, social and cultural habits and behavioural upheavals. The dilemma of balancing metabolic control against quality of life is accentuated in childhood.

Adverse societal influences sabotage attempts at achieving good glycaemic control and cardiovascular protection. UK children often have unstructured meal patterns, eat poor quality food (high in saturated fats) and consume excessive sweet foods.

To counterbalance increasing expectations of improved metabolic control there is an ever increasing incidence of type 1 diabetes, the emerging numbers of type 2 and rising numbers of secondary causes of diabetes in the larger children's diabetic clinics.

National surveys of children's services have shown considerable improvements but major deficiencies remain. Outcomes in the UK in terms of metabolic control do not compare favourably with some international centres and the challenges for the future include improvements in the organisation of care, staffing levels and structures, and improved collaboration between children's and adult services in expanded centres of excellence for the management of childhood diabetes. Copyright © 2004 John Wiley & Sons, Ltd.