Re: Is the NHS best practice tariff for type 1 diabetes applicable in the irish context?

Sir, We refer to the IMJ article “Is the NHS Best Practice Tariff for Type 1 Diabetes Applicable in the Irish Context?”¹, we commend the focus of this article, in highlighting the importance of tight metabolic control in the paediatric population, despite the intrinsic challenges childhood and adolescence present in this regard. We too, have recently completed an audit of our service for the year 2013 and have found it to be a worthwhile exercise. The recently published report on the Irish Childhood Diabetes National Register confirms Ireland as a high incidence area of Type 1 Diabetes, with the incidence rate for Ireland lying in the top quartile for Europe. Indeed the incidence of Type 1 Diabetes in the Irish paediatric population has increased substantially from 16.3 to 27.5 per 100,000 per year between 1997 and 2008². The Diabetes Control and Complications Trial and follow up studies indicate that, 5-7 years of poor glycaemic control, even during adolescence can result in an increased risk of micro- and macro-vascular complications in the subsequent decade. Hence reiterating the importance of intensive control in this population.