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Auditing and standardising care for young people with diabetes: beginning a process to improve outcomes

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Clear goals, uniform practices, and expectations influence outcomes for young people with diabetes

Diabetes mellitus is a state of dysregulated metabolism caused by varying degrees of insulin deficiency, compounded by resistance to its metabolic actions. In type 1 diabetes, the most common form in children and adolescents, severe insulin deficiency caused by an autoimmune process triggered by environmental factors ultimately leads to near total loss of insulin secretion, necessitating its replacement. Type 2 diabetes, associated with insulin resistance, obesity and genetic or acquired defects in insulin secretion, affects only 5–10% of children and adolescents with diabetes.1 Hyperglycaemia is the most convenient feature to check in patients, by measuring blood glucose levels several times each day; HbA1c levels can be assessed for longer term monitoring, while abnormalities in protein and fat metabolism are checked periodically. The overall costs to any national health service of daily treatment and later complications are staggering: and, as the numbers of people with types 1 and 2 diabetes are increasing worldwide, so too are the costs.2

The micro- and macrovascular complications of diabetes are related to the degree of metabolic control; moreover, stricter metabolic control at the onset of type 1 diabetes imparts long lasting metabolic benefits…