The organization of services for children with diabetes in the United Kingdom: report of the British Paediatric Association Working Party.

A British Paediatric Association Working Party was set up in 1987 to examine the organization of services for children with diabetes in the United Kingdom. A questionnaire survey identified 360 consultant paediatricians providing care for children with diabetes in 205 Districts or Health Boards. Sixty-three per cent (227) of paediatricians saw children in a designated paediatric diabetic clinic, 61% (220) reported that a diabetes nurse specialist regularly attended the clinic, and 70% (251) that a dietitian did so. Haemoglobin A1 or other glycosylated proteins were regularly measured by 91% (326) of paediatricians, 76% (274) regularly tested for urinary protein, and 79% (285) and 86% (310) checked blood pressure and eyes, respectively. However, 27% (55) of the Districts or Health Boards in the survey had no designated paediatric diabetic clinic. When the data were analysed by assigning paediatricians to categories according to their degree of specialization in diabetes only 33% (118) paediatricians could be described as having a specialist interest in diabetes. There were significant differences in the services provided by the specialist paediatricians when compared with the non-specialists, particularly with respect to the professional staff regularly seeing children in clinics and services to the adolescents. The Working Party recommends that services for children with diabetes may be improved by encouraging at least one paediatrician in each District to develop a special expertise in diabetes. Designated children's diabetic clinics with appropriate supporting staff and services should be available in all Districts.