CHILDREN and young adults with diabetes continue to experience marked variation in care across England, with a new national report outlining practical steps to improve outcomes, expand access to technology, and standardise services for people aged 0–25 years.
The national report from Getting It Right First Time (GIRFT), produced in partnership with the NHS Diabetes Programme, presents the most comprehensive review to date of diabetes services for children and young adults. Drawing on a nationwide assessment of all 42 Integrated Care Boards (ICBs), the report examines how services are organised, identifies unwarranted variation in care, and sets out recommendations to support more equitable, evidence based care.
Around 56,000 children and young adults in England are living with Type 1 diabetes, while a further 9,000 have early onset Type 2 diabetes. The report emphasises that effective diabetes management during childhood and early adulthood is critical for long term health, independence, and emotional wellbeing.
The review identified substantial differences in clinical outcomes between services despite comparable patient populations. Median glycated haemoglobin (HbA1c) values across paediatric diabetes units ranged from 54.8 mmol/mol to 70.5 mmol/mol, suggesting considerable variation in care delivery rather than differences in case mix.
Essential diabetes health checks also varied widely. While some paediatric diabetes units completed all six recommended annual health checks for 98% of eligible young people with Type 1 diabetes, others achieved completion rates of just 6%. The review also highlighted inconsistent access to psychological professionals with diabetes expertise, variation in treatment intensification pathways, and differences in access to specialist therapies.
Emergency admissions for diabetic ketoacidosis and severe hypoglycaemia remained another area of concern, with variation observed in both admission rates and implementation of inpatient protocols.
Access to hybrid closed loop technology emerged as another key area of unwarranted variation. Although the technology is recommended by the National Institute for Health and Care Excellence (NICE) and supported through NHS England investment, uptake among children aged 0–18 years ranged from 37% to 79% across ICBs. According to the report, these differences appeared to reflect system level factors, including procurement processes, workforce capability, and digital infrastructure, rather than population need alone.
The review also identified young adulthood as a particularly vulnerable period, with increasing glycated haemoglobin levels, higher emergency admission rates, and reduced support following transition from paediatric to adult services. Recommendations include developing dedicated young adult care pathways, embedding digital self management tools, and expanding relationship based support through youth workers and service navigators.
To address these disparities, the report calls for stronger clinical leadership, integrated data systems, and nationally agreed minimum standards for children and young adults with diabetes, with the aim of ensuring consistent, high quality care regardless of where patients live.
Getting It Right First Time (GIRFT). Children and young adults diabetes national report: summary and recommendations. 2026. Available at: https://gettingitrightfirsttime.co.uk/wp-content/uploads/2026/07/CYA-diabetes-national-report-summary-and-recommendations-280726.pdf. Last accessed: 6 August 2026.
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