There has been a remarkable overall trend of improved care delivery and outcomes in paediatric diabetes in England over the past 10 years, most notably the 11 mmol/mol (1%) reduction in median HbA_1c (Royal College of Paediatrics and Child Health [RCPCH], 2022). This has been driven by the introduction of the paediatric diabetes Best Practice Tariff along with the synergistic efforts of the National Paediatric Diabetes Audit (NPDA, 2021), the National Children and Young Peoples Diabetes Network (NCYPDN), and more recently, the National Diabetes Quality Programme. 

There are common themes that have led to success across all these initiatives, at national, regional and service level. These include excellent leadership, a strong collaborative multidisciplinary approach and the dedication of healthcare professionals to provide the highest quality of care, putting children and young people (CYP), and their families at the centre of all they do. These groups are united in their relentless pursuit of improvement, driven by high-quality data, and it was heartening to see a NPDA unit participation rate of 100% in the recently published report, despite the significant challenges of the pandemic. This demonstrates a clear commitment from the clinical community to continue to use data to benchmark services and drive improvement.  

Despite these achievements, national audit data also demonstrates some concerning trends that must be addressed. Although overall care delivery and outcomes have improved, a picture of widening health inequalities has emerged. The use of insulin pumps and continuous glucose monitoring (CGM) is associated with improved glycaemic control and quality of life, but access is lowest in CYP living in more deprived areas, and in those of non-white ethnicity. There is also stark regional variation in access to treatment technologies and health outcomes (RCPCH, 2022). 

Outcomes during adolescence and young adulthood decline, including a spike in diabetic ketoacidosis (DKA) admissions at 18 years of age (NHS Digital, 2022) and increasing numbers of CYP are developing type 2 diabetes with a pattern of health inequalities within this group (RCPCH, 2022). 

The formation of a clinically led Children, Young Adults and Diabetes Oversight Group (NHS England and NHS Improvement [NHSEI]) has established system-wide oversight and governance. This is particularly important as we move towards a new operating model in the NHS, where Integrated Care Systems will be accountable for using their budgets to deliver local health and care services and improve outcomes through a population health management approach. 

The Oversight Group has developed a focused work plan to improve care and outcomes for CYP with diabetes and is aligned to the NHS Long Term Plan priority to move to a 0–25 years’ service model. The group brings together key national stakeholders including the NHSEI CYP Transformation Programme, NHSEI Diabetes Programme, NCYPDN, the Association of Children’s Diabetes Clinicians, the RCPCH and Diabetes UK. Funds have been made available for sustainable clinical leadership, programme support and development of governance arrangements nationally and within each region to support delivery of these aims. 

Four key areas of focus

1. Reducing health inequalities and variation in outcomes for CYP with diabetes, including more equitable access to treatment technology. 

2. Reducing current variation between paediatric diabetes units, for example care process delivery and treatment target achievement.

3. Improving care for those transitioning from paediatric to adult care and addressing the poorer outcomes for CYP with diabetes at transition age.

4. Improving care and outcomes for CYP living with type 2 diabetes.

Despite the considerable challenges of delivering care throughout the pandemic and uncertainty with the changing NHS landscape, progress in diabetes care has been sustained and we have new opportunities to tackle these health inequalities. There is widening access to CGM and hybrid closed loop systems have become available. Through taking a co-ordinated, data-driven approach to address these key areas of focus, we must now ensure equitable access to high-quality diabetes care for every CYP living with diabetes.