title: Care for children and adolescents with diabetes in New Zealand District Health Boards: Is the clinical resourcing ready for the challenge?
abstract: OBJECTIVE
  Landmark studies, including the Diabetes Control and Complications Trial, have demonstrated the need for intensive management and improvement of glycaemic control in children and adolescents with Type 1 Diabetes (T1DM). Our aim was to determine what clinical resources were present in New Zealand to manage diabetes in children and adolescents and compare this with international recommendations, via the Paediatric Society of New Zealand clinical network.
  
  
  METHODS
  All 21 District Health Board (DHB) secondary care sites in New Zealand managing children and adolescents with diabetes were invited to complete a survey about the specialist services they provided in 2012.
  
  
  RESULTS
  All of the identified 21 sites (encompassing 20 centres) replied. These centres managed 1,587 children and adolescents with diabetes up to 18 years of age (>95% with T1DM), including 251 (16%) on insulin pumps. Average clinic HbA1c was not available for many centres. Staffing for specialists (general paediatricians or paediatric endocrinologists) was low (median 0.2/100 patients, range 0.1-0.4), but was relatively higher in diabetes nurses (median 0.7/100 patients, range 0.1-1.8). Despite the psychological and social burden of diabetes, the two allied health disciplines (psychology services and social worker) were the hardest to quantify as dedicated resource in these disciplines did not exist in all but three centres.
  
  
  CONCLUSIONS
  This survey suggests that the majority of clinical services providing care for children with diabetes in New Zealand are significantly under-resourced.
authors.affiliation: Paediatric Diabetes and Endocrinology Service, Starship Children's Hospital, Park Road, Grafton, Auckland 1050, New Zealand. Craigj@adhb.govt.nz.
authors.forename: Craig
authors.initials: C
authors.lastname: Jefferies
authors.forename: Neil
authors.initials: N
authors.lastname: Owens
authors.forename: Esko
authors.initials: E
authors.lastname: Wiltshire
mesh_terms: D000293:Adolescent; D002648:Child; D002662:Child Health Services / Q000458:organization & administration / Q000706:statistics & numerical data*; D002675:Child, Preschool; D003922:Diabetes Mellitus, Type 1 / Q000453:epidemiology / Q000628:therapy*; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D009520:New Zealand / Q000453:epidemiology; D010348:Patient Care Team / Q000706:statistics & numerical data; D010561:Personnel Staffing and Scheduling / Q000706:statistics & numerical data*; D015995:Prevalence; D011795:Surveys and Questionnaires; D055815:Young Adult