Before the onset of late complications, significant excess mortality existed following the diagnosis of type 1 diabetes in childhood, even in recent years. Variation between countries in this excess could not be explained.

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Aims To examine all-cause and cause-specific mortality in a population-based cohort of people with early and late onset of Type 1 diabetes.Methods The Yorkshire Register of Diabetes in Children and Young People includes individuals with early (0-14 years) and late (15-29 years) Type 1 diabetes onset, diagnosed between 1978 and 2013. This register was linked to death certification data from the Office for National Statistics to calculate standardized mortality ratios, cumulative mortality curves using Kaplan-Meier survival estimates, and Cox regression modelling. Ethnicity was derived using Onomap. Deprivation status was classified using the Townsend index. The underlying cause of death in each case was clinically verified.Results There were 229 deaths in 5498 individuals with 100 959 person-years of follow-up. The overall standardized mortality ratio was 4.3 (95% CI 3.8 to 4.9). There were no significant differences in standardized mortality ratios according to age of onset, sex or deprivation status. The standardized mortality ratios were significantly higher for people of white ethnic origin [8.1 (95% CI 6.9 to 9.4)] than for those of South-Asian ethnic origin [3.4 (95% CI 1.7 to 6.4)]. The mortality risk was lower in those diagnosed in later years (2002 to 2013 for the early-onset and 2006 to 2013 for the late-onset group) compared with earlier years (1991 to 1997 for the early-onset and 1991 to 1997 for the lateonset group) for both onset groups [hazard ratio 0.13 (95% CI 0.05 to 0.33) vs 0.24 (95% CI 0.07 to 0.81)]. Mortality risk improved over time for chronic complications in the early-onset group only, but there was no improvement in either onset group with regard to acute complications.Conclusions An excess of deaths in the population with Type 1 diabetes remains. Although the all-cause mortality risk has fallen over time, no improvement has been found in the mortality risk associated with acute complications.

The aim of this study was to document the clinical and secondary care cost benefit of continuous subcutaneous insulin infusion (CSII) over a five‐year period in the Leeds Paediatric Diabetes Service. Patients with type 1 diabetes treated using CSII therapy since 2002 who attended the paediatric diabetes clinics in Leeds, UK, were eligible for inclusion. Information on glycaemic control (HbA1c) and frequency/type of hospital admission was collected during the 12‐month period before CSII was initiated and compared prospectively after the transition to pump therapy. Multi‐level regression modelling was used to assess the change in HbA1c levels and the effect of patient characteristics. Data were included on 84 individuals ranging in age from 0 to 18 years, 54% of whom were female. Mean (SD) HbA1c levels improved from a baseline of 9.4 ± 1.7% to 8.9 ± 1.5%, with a significant overall reduction of 0.53% within the first year (95% CI 0.29‐0.78%). The improvement in HbA1c levels was sustained for up to five years after CSII therapy commenced. Regression modelling showed that age, sex and duration of diabetes were not significantly associated with change in HbA1c levels. Hospital admission rates fell for severe hypoglycaemia from 8.9 to 2.4 per 100 patient years although hyperglycaemia admissions remained largely the same (7.6 vs 7.3 on CSII per 100 patient years). We concluded that patients treated using CSII appear to exhibit both improved glycaemic control, which is sustained over the short/medium term, and lower hospital admission rates for hypoglycaemia. Copyright © 2009 John Wiley & Sons.

Our population-based clinical audit of children with diabetes is the product of an effective collaboration between those who deliver care and health services researchers. High levels of recording the key care process measuring diabetes control, compared with national figures, suggests collaboration has translated into improved services. The interesting association between poor diabetes control and higher deprivation is noteworthy and requires further investigation. Future audits require recording of clinical management and clinic structures, in addition to resources to record, assemble and analyse data.

We examined mealtime interactions to assess whether they varied according to maternal body mass index, country and mode of feeding in 41 Israeli and UK mother–infant dyads. Feeding behaviours were coded using the Simple Feeding Element Scale. Significantly, more UK mothers breastfed during the filmed meal compared to Israeli mothers. Mealtime interactions did not vary according to maternal body mass index or country. Women who breastfed (as opposed to those who bottle fed or fed solids) provided fewer distractions during the meal, a more ideal feeding environment and fed more responsively.

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The additional resources required to pay for insulin pump therapy for a small proportion of the diabetes population would be minimal given the potential benefits to these patients of improved control and anticipated reduction in long-term morbidity.