The results of a 1994 survey of consultant paediatricians in the UK were compared with those of a 1988 survey to assess how the organization of services for children with diabetes had changed. We found evidence of a substantial improvement, in line with the recommendations of the 1988 BPA Working Party Report on the Organization of Services of Children with Diabetes. Key features of this improvement included a service rationalization with fewer consultants (325 versus 360) providing care for more children: 45% with a clinic size of over 40 children compared with 23% in 1988. More consultants saw children in a designated paediatric clinic (88 % compared with 63%) and expressed a special interest in diabetes (48% compared with 32%). Eighty-seven % of consultants had a diabetes nurse specialist regularly attending the clinic (vs 61% in 1988) and 91% (vs 75%) reported that a dietitian attended regularly. Although more consultants had a psychologist or psychiatrist attending the clinic, these specialists remained a scarce resource (20% compared with 9% in 1988). Continuing deficiencies in the quality of service for some children were identified with small cohorts of children being managed in general paediatric clinics with inadequate expert support staff; there was a widespread shortage of diabetes nurse specialists and only 30% of those in post worked full time with children. In addition 52% of consultants expressed no special interest in diabetes and 10% did not regularly monitor glycated proteins. Continuing improvement of services for children with diabetes in the UK is needed.
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Haines et al. (1997) studied this question.