The incidence of type 1 diabetes mellitus continues to increase with an estimated rise in incidence rates of between 3% and 5% per year.^1,2 This increase has been most pronounced in the pre-school age group.^3,4

The rising incidence has been paralleled by the increasing intensity of management of this condition. The Diabetes Control and Complications Trial (DCCT) study group demonstrated the importance of intensive diabetes management and subsequent strict glycaemic control, with significant reductions in microvascular complications with small changes in HbA1c.⁵ However, intensive diabetes management is associated with a potential increased risk of severe hypoglycaemia.^6,7 Efforts to achieve near-normoglycaemia as early as possible after diagnosis should be considered based on the “tracking phenomenon” data which suggest a correlation between metabolic control in the early stages of treatment and that in subsequent years.⁸

The importance of intensive diabetes management has significant implications for toddlers and infants diagnosed with diabetes and for the children’s diabetes services who look after them. This age group has particular features and clinical characteristics which makes their care distinct from that of older children with diabetes. This article will review the main clinical areas in the management of these children.

EPIDEMIOLOGY

Oxford data suggest an incidence rate in the UK of type 1 diabetes mellitus in children <2 years of age of about 1:15 000.⁴ Approximately 4% of children with type 1 diabetes are less than 2 years of age at diagnosis.⁹ This suggests that there are several hundred children being cared for in the UK and Ireland who were diagnosed at this age. These relatively small numbers must necessarily limit an individual diabetes clinic team’s experience in the management of infants and toddlers with diabetes.

It is thus vital for diabetes health professionals in training to …