The vast majority of children and adolescents diagnosed with type 1 diabetes live a fulfilling and appropriate life in modern developed society. Readily available insulin therapy, blood glucose monitoring and comprehensive education and support programmes delivered by health professionals trained in paediatric diabetes allow children to grow and develop normally and attend standard education with participation in virtually all activities of their choice. While the burden of diabetes management sometimes weighs heavily on young people and their families, the majority cope with the daily routine of diabetes for most of the time. The main acute complications of diabetes, hypoglycaemia and diabetic ketoacidosis, are a persisting concern but in well organised health services efficient health support systems deliver rapid management plans for patients and their families that aim to prevent hospitalisation. Previous diabetes complications such as increased infections (eg, injection abscesses), poor growth and lipo-hypertrophy have in the main been eliminated. Over 80 years after the discovery of insulin, therefore, should there be reason for optimism about the long term outcome of diabetes in the young?

WHAT IS THE RISK OF LONG TERM HEALTH COMPLICATIONS?

Optimism for the future depends on the long term health prospects for young people diagnosed with diabetes in their first and second decades of life. Current data provide confusing evidence. Most cohort studies show that there is an increase in the absolute risk of cardiovascular disease (CVD) in adults with type 1 diabetes.1^–3 In a large cohort study, recent data from the UK confirmed this risk as well as an increased relative risk of CVD morbidity and mortality in adult patients with type 1 diabetes compared with those without diabetes.4 The overwhelming majority of these adults, who start to experience CVD events in their fourth and fifth decades of life, were diagnosed with type 1 diabetes at an average age of …