The incidence of childhood onset type 1 diabetes has doubled over the past 10 years,1 and this has long term implications for the risk of diabetic complications. Adolescence seems to be a crucial period because diabetic microangiopathic complications, such as microalbuminuria and retinopathy, are rarely seen before the age of 11, although the prepubertal duration of disease and glycaemic control are important.2

In the linked study (doi: 10.1136/bmj.a918), Gallego and colleagues report that 36% of young people aged 11-18 years screened in a well resourced central assessment unit in Australia developed diabetic retinopathy after a relatively short duration of diabetes (median 4.9 years).3 In a recent BMJ study, Amin and colleagues reported a 26% incidence of microalbuminuria during adolescence in an inception cohort of 527 young people, followed for a mean of 9.8 years.4 They also found that the cumulative prevalence may be as high as 50%, much higher than that seen in a similarly designed adult cohort, and that both persistent and intermittent microalbuminuria may …