Tight glycaemic control in adolescents with Type 1 diabetes reduces the long-term risk of developing microvascular complications.1 Although diabetes in adolescence is classically associated with a high glycated haemoglobin (HbA1c), many overseas centres are achieving a mean HbA1c of <9.0%.2 The Diabetes Control and Complications Trial (DCCT) demonstrated that strict metabolic control could be achieved in adolescence, with both an intensified insulin injection system and also intensive clinical follow up.1 Also, technological advances such as insulin pump therapy (continuous subcutaneous insulin infusion) allow tight control to be achieved, with a reduction in hypoglycaemic events when compared to conventional subcutaneous injections.2

We wish to report HbA1c results from our local adolescent population. Patients with established diabetes of one year or longer duration, who were residing in the Christchurch Diabetes Centre’s catchment area in the year 2001, were identified from a clinical database. Their identity was rechecked against an independent population-based research register.3 There were no patients present on one database who had been omitted from the other database, thus patient ascertainment appears near complete. The data below are therefore representative of the entire diabetic population, rather than a subgroup of regular clinic attenders.

Resource constraints limit the frequency of physician follow up, with the average review period being every six months. No patient was using insulin pump therapy, there being no publicly funded provision for this. The service does, however, offer a structured paediatric–adult physician handover visit, and specialist clinical psychology support is accessible. Patients are encouraged to consider a multiple daily insulin injection regimen, yet 57% elected to inject twice or three times a day only. There was, however, no relationship between frequency of injections and HbA1c.

The mean HbA1c was 10.2% for females, compared to 9.5% for males (p = 0.042).

We are concerned that the high mean HbA1c in our region will translate to a high rate of development of microvascular complications in the long term. In the current healthcare environment, there is a strong focus on preventing and managing adult Type 2 diabetes. Adolescent service delivery is in danger of being neglected by default. Strategies clearly need to be devised to reduce the mean HbA1c in this age group. This will require both cooperation between paediatricians and adult physicians and sufficient allocation of resources to implement new clinical strategies.

The epidemic of Type 2 diabetes has been well publicised, with a doubling of new cases predicted for New Zealand over the next fifteen years.4 There is also an epidemic of Type 1 diabetes in childhood and adolescence, with a four fold rise in incidence since 1970 and a doubling in rate over the last decade. There is no evidence that this progressive increase is abating. Debate is therefore needed about the best use of diabetes resources, in relation both to intergenerational allocation of resources and with regard to the best mix of primary and secondary care input.

In conclusion, we trust that these population-based data will be of use as a benchmark for other adolescent diabetes services and hope that other centres will present their own clinical data. We encourage debate about the most effective way of delivering adolescent diabetes services in New Zealand and are especially interested in hearing about service delivery strategies from regions that have managed to achieve tight glycaemic control in this age group.