VIEWPOINT Short report: Care for children and adolescents with diabetes in Australia and New Zealand: Have we achieved the defined goals? Fergus Cameron, 1 Andrew Cotterill, 2 Jennifer Couper, 3 Maria Craig, 4,5,6 Elizabeth Davis, 9,10 Kim Donaghue, 4,5 Timothy Jones, 9,10 Bruce King 7,8 and Barbara Sheil 10 1 Department of Endocrinology and Diabetes, Royal Children’s Hospital, University of Melbourne, Murdoch Children’s Research Institute Parkville, Melbourne, Victoria, 2 Department of Paediatric Endocrinology, Mater Children’s Hospital, Brisbane, Queensland, 3 Department of Diabetes and Endocrinology, Women’s and Children’s Hospital and Discipline of Paediatrics, University of Adelaide, Adelaide, South Australia, 4 The Children’s Hospital at Westmead, Sydney, 5 Discipline of Paediatrics and Child Health, The University of Sydney, 6 School of Women’s and Children’s Health, University of New South Wales, Sydney, 7 School of Medicine, Faculty of Health, University of Newcastle, 8 Department of Paediatric Endocrinology, John Hunter Children’s Hospital, Newcastle, New South Wales, 9 Department of Endocrinology and Diabetes, Princess Margaret Hospital for Children, and 10 Centre for Child Health Research, University of Western Australia, Telethon Institute for Child Health Research, Perth, Western Australia, Australia Introduction The landmark Diabetes Control and Complications Trial (DCCT), by demonstrating a reduction in microvascular compli- cation rate in intensively treated adults and adolescents with type 1 diabetes (T1DM), placed responsibility on adult and pae- diatric diabetologists to strive to assist patients to achieve improved glycaemic control. 1,2 The inclusion of an adolescent subgroup was important for paediatric diabetes clinicians because it confirmed that glycaemic control was the most important modifiable risk factor in complication development even in the young. In Australasia, the paediatric diabetology community responded with a call for all children and adoles- cents with diabetes to be treated with intensive management, with the aim of improving long-term outcomes and prognosis into adulthood. 3,4 Furthermore, there is now an increasing body of evidence that metabolic and psychological paediatric out- comes in diabetes are strong determinants of adult outcomes. 5,6 In the near two decades that have followed, there has been a continued rise in the incidence of childhood onset T1DM. 7–12 At the same time, there has been a dramatic improvement in potential treatment approaches with the introduction of ana- logue short- and long-acting insulins, improved pump therapy and recently, new means to monitor glucose levels through continuous glucose monitoring systems. 9,13–16 On the other hand, there has not been a consensus or initiative on the staffing resources allocated to diabetes care in children despite diabetes being endorsed as a National Health Priority Area at the Aus- tralian Health Ministers’ Conference in 1996. 17 In 2010, the Australasian Paediatric Endocrinology Group formed a national Children’s Diabetes Network that represented clinical teams managing over 95% of young people with T1DM in Australia and New Zealand. Through this organisation, we have been able to assess whether the goals of the post DCCT call to universal intensive management of childhood onset diabetes have been achieved in Australia and New Zealand. Methods Centres All specialised centres who manage children and adolescents (0–18 years) were invited to participate. A total of 17 centres were included (Table 1). The number of centres by Australian State was: Victoria = 2; New South Wales = 3; Queensland = 6; South Australia = 1; Western Australia = 1; Tasmania = 1; and the Australian Capital Territory = 1; two centres were included from New Zealand. A total of 7559 children and adolescents were managed by these centres and clinics. Clinic size ranged from 54 to 1620, and the 10 clinics that had 300 or more patients represented 90.6% of the patient group. The smaller clinics were located either in regional Queensland centres or in Tasmania. The majority (>90%) of children with diabetes were managed in large tertiary centres that also provided outreach services. All centres completed a survey that determined staff working in the diabetes service as well as other resources available, including level of access to a database facility. Centres reported frequency of patient visits, ability of patients and families to access allied health and psychological services, and, where avail- able, glycated haemoglobin (HbA1c) outcomes for 2010. Staffing, resources and outcomes Each centre reported the number of staff (full-time-equivalents (FTEs)) employed to manage diabetes including specialist endo- crinologists, junior medical staff, dietitians, social workers and psychologists, exercise physiologists or physiotherapists, and podiatrists. They also reported whether they provided outreach services and had a database as a clinical or research tool. Clinics also reported the median number of visits that each child with diabetes attended during a year. Those centres with access to the information calculated the proportion of the children with diabetes attending their centre who had a mean HbA1c in 2010 that was less than 7.5% Correspondence: Dr Timothy W Jones, Department of Endocrinology and Diabetes, Princess Margaret Hospital for Children, PO Box D184, Perth, WA 6840, Australia. Fax +61 8 9340 8605; email: tim.jones@health.wa.gov.au Conflict of interest: There is no conflict of interest. Authors: APEG Diabetes Group writing committee on behalf of the group. Accepted for publication 12 June 2012. doi:10.1111/jpc.12145 Journal of Paediatrics and Child Health (2013) © 2013 The Authors Journal of Paediatrics and Child Health © 2013 Paediatrics and Child Health Division (Royal Australasian College of Physicians) 1