Diabetes in the young: past, present and future

ABSTRACT Optimal management of diabetes in children and adolescents continues to presentdifficult challenges. Constant and unpredictable changes in growth, development andphysiological maturity are compounded by problems of brittle families, social andcultural habits and behavioural upheavals. The dilemma of balancing metabolic controlagainst quality of life is accentuated in childhood.Adverse societal influences sabotage attempts at achieving good glycaemic controland cardiovascular protection. UK children often have unstructured meal patterns, eatpoor quality food (high in saturated fats) and consume excessive sweet foods.To counterbalance increasing expectations of improved metabolic control there isan ever increasing incidence of type 1 diabetes, the emerging numbers of type 2 andrising numbers of secondary causes of diabetes in the larger children’s diabetic clinics.National surveys of children’s services have shown considerable improvements butmajor deficiencies remain. Outcomes in the UK in terms of metabolic control do notcompare favourably with some international centres and the challenges for the futureinclude improvements in the organisation of care, staffing levels and structures, andbetter collaboration between children’s and adult services in expanded centres ofexcellence for the management of childhood diabetes. Copyright © 2004 John Wiley &Sons, Ltd.