Foreword Globally, diabetes is a disease in evolution. These global changes in diabetes are also affecting children and adolescents, and the incidence of all types of diabetes is rising. In many parts of the world type 1 diabetes in childhood is increasing by 3–5% per annum whilst type 2 diabetes is declaring itself in younger and younger age groups. These children have a lifetime of diabetes ahead, and the new International Society for Pediatric and Adolescent Diabetes (ISPAD) Consensus Guidelines are aimed at providing health care providers with clear guidance in both acute and chronic care. ISPAD is a professional organization whose aims are to promote science (clinical and basic), education and advocacy in childhood and adolescent diabetes. The strength of ISPAD lies in the scientific clinical expertise of its membership in childhood and adolescent diabetes (550 members from over 70 countries). This international breadth of experience is reflected in these guidelines, which can be adapted or adopted by health professionals looking after children and adolescents in any country. The guidelines are thus a consensus of best practice recommendations from around the world and reflect the art of medicine as well as the latest in evidence-based information. Guidelines need to be living documents and to reflect the changing nature of a disease, clinical practice as well as new knowledge. These guidelines are much expanded from the ISPAD Consensus Guidelines for the Management of Insulin-Dependent (Type 1) Diabetes (IDDM) in Childhood and Adolescence which were published in 1995. The new edition recognizes the emerging problem of type 2 diabetes and addresses all forms of diabetes affecting children and adolescents. The International Diabetes Federation, which represents member diabetes associations from over 130 countries in all continents, has warmly endorsed these guidelines. The guidelines will be freely available to all health professionals with a special interest in childhood and adolescent diabetes and will be distributed in a printed as well as an electronic format (www.ispad.org). It is hoped that the guidelines will stimulate each country to develop appropriate standards of care for childhood and adolescent diabetes and result in improved delivery of care. A task as important as this could not have been achieved without the dedication and hard work of many people. In writing this foreword on behalf of ISPAD, I wish to thank all of those who gave so willingly of their time and expertise. I wish to pay particular tribute to Dr Peter Swift for his outstanding editorship in collating the many contributions and promoting debate in order to achieve consensus, and to Dr Ragnar Hanas not only for his editorial contributions but also for posting the drafts on the website that he has developed for ISPAD. The process of developing the guidelines required the support of industry, and on behalf of ISPAD I wish to thank Novo Nordisk for its generous financial backing, for its global vision and for its commitment to education in childhood and adolescent diabetes. Martin Silink President ISPAD