Objective-To investigate the relationship between clinic provision, co
nsultant and nursing caseload, and processes and outcomes of diabetes
care in children. Design-Retrospective audit in the South Western regi
on of England of 801 children and young people with diabetes; 701 were
seen in a designated clinic, Seven of 21 consultants fulfilled the Br
itish Paediatric Association (BPA) criteria for a specialist in childh
ood diabetes. Seventeen nurses provided specialist care. Main outcome
measures-Glycated haemoglobin, admissions to hospital clinic attendanc
e rates, contacts with a dietitian, measurements of height and weight,
and screening rates for hypertension, microalbuminuria, and retinopat
hy. Results-Children under the care of 'nonspecialists' had higher adm
ission rates to hospital with all diabetes related problems and for hy
poglycaemia and lower screening rates for microalbuminuria than those
under 'specialists'. Children under the care of the two tertiary hospi
tal consultants had lowest glycated haemoglobin results, spent least t
ime in hospital at diagnosis, were most likely to have their heights a
nd weights plotted, and to be screened for microalbuminuria and retino
pathy, had higher admission rates, lower clinic attendance rates, and
fewer dietitian consultations. Higher nursing caseloads were associate
d with longer periods of admission at diagnosis, better clinic attenda
nce rates, reduced rates of admission after diagnosis, and less likeli
hood of having blood pressure measured and being screened for microalb
uminuria. Children attending general paediatric clinics were less Like
ly to be seen by a dietitian and to have their height and weight plott
ed. Conclusions-The results are consistent with the recommendation of
a BPA working party in 1990 that children with diabetes should be care
d for by specialist paediatricians with a caseload of more than 40 chi
ldren, and that children should be seen in a designated diabetic clini
c.