Kathleen Lynch (Cork North Central, Labour)

Currently it is estimated there are between 3,000 to 4,000 children and young adults under 16 years of age with diabetes in this country. The majority of patients have type 1 diabetes, more than 90%, but unfortunately there is an increasing number of young patients developing type 2 diabetes. The incidence of type 1 diabetes is also increasing by about 2% to 3% per year and experts anticipate that over the next ten to 15 years the incidence of type 1 diabetes will double.

Type 1 diabetes is a particularly complex condition in children and young adults and so it is recommended that their care be delivered in a multidisciplinary setting with access to a consultant paediatric endocrinologist, paediatric diabetes specialist nurse, paediatric specialist dietician, psychologist and social worker. Because of the complexity of the condition and the significant dangers of hypoglycaemia there can be a clinical advantage in having continuous subcutaneous insulin infusion therapy for children and young adults with type 1 diabetes.

The HSE has established a national clinical programme for diabetes in 2010 with the express aim of defining the way diabetic clinical services should be delivered, resourced and measured. One of the key priorities is to facilitate future organised care and screening for diabetes-related complications. There are two proposed models of care to improve the situation for paediatric diabetes care.

The first model is from the HSE expert advisory group report, chaired by Dr. Colm Costigan, paediatric endocrinologist in Our Lady's Hospital for Sick Children in Crumlin. This model proposes that care be centralised for each region in a dedicated paediatric-adolescent diabetes centre looking after at least 150 children-adolescents and ideally, the centre should be in a regional hospital that has an adult diabetes centre to facilitate transition to adulthood. The centre should be led by a paediatrician with a special interest and training in diabetes. The report also recommended amalgamation of the Dublin centres into a national tertiary centre that would act as a resource to assist the regional centralisation.

The second model comes from the recent Diabetes Federation of Ireland Diabetes Action report. This report recommends the establishment of eight to ten regional networks with the three existing Dublin centres acting as tertiary reference centres and continuing to see one third of the national paediatric-adolescent diabetes population. Within each hospital in the region from existing resources, a paediatric nurse would be identified to care for children with diabetes in that hospital. The network team would deliver care at existing centres around the country and travel to outreach clinics as required. To move this plan forward, the national clinical leads for diabetes and paediatrics are to meet in the next couple of weeks to propose the following: the establishment of a joint subgroup with representatives from the paediatric and diabetes working groups to address paediatric diabetes care; to perform a gap analysis to determine the current existing diabetes service across the country for paediatrics and young adolescents; to agree on a model of care for children and adolescents with diabetes; to standardise paediatric diabetes emergency care across the country; to standardise hospital diabetes care across the country; to develop criteria for use of continuous subcutaneous insulin infusion therapy in children and adolescents with type 1 diabetes; and to work on prevention and public health policy to prevent and to aid early detection of diabetes in young children and adolescents.

Ultimately, the function of the HSE national programme for diabetes, among others, is to consider which model is most appropriate and it is working to this end. In parallel, the Department of Health and the HSE will be meeting the Diabetes Federation of Ireland with a view to progressing the issues around the appropriate model of care for children and adolescents with diabetes.

Finally, there have been the following important developments in this area. The national diabetes programme is continuing the development of a national diabetic retinopathy screening programme. While retinopathy screening is continuing in the north-west region, the intention is that services be rolled-out nationally in 2012. This programme is significant because diabetic retinopathy is the leading cause of blindness and serious visual impairment in Ireland. A total of 90% of people with diabetes will develop retinopathy while 10% will be sight threatened if undetected and not treated. A national foot-care model has been agreed. The aim for 2011 is to establish 16 specialist multidisciplinary foot care teams across the country in line with indicative national hospital reconfiguration which will have different levels of care for patients depending on their risk of diabetic foot disease. Taken together, it is envisaged that these planned services, once operational, will enhance overall diabetes care provided for children and adolescents in Ireland.

I thank the Deputy and I hope we can at long last provide a service to these people.

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