The Association of British Clinical Diabetologists (ABCD) has consistently promoted the need to ensure the highest quality care for people with type 1 diabetes. In 2012 it ran a campaign to raise awareness of their plight under the banner 'The Lost Tribe'. This arose from concerns that people with type 1 diabetes had inadvertently been let down by wholesale system change, repatriating people from secondary care diabetes clinics to primary care. While the preparation for this included

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... primary care teams to manage people with type 2 diabetes and to recognise those requiring specialist input, many people with type 1 diabetes were repatriated to teams that lacked a specialist understanding of their needs, and have subsequently been denied access to specialist care because they are meeting their glycaemic targets. People with type 1 diabetes are particularly sensitive to imprecise language used by some healthcare professionals, politicians and the press, which implies that their diabetes could have been prevented by eating less and being more physically active. The outcome data for type 1 diabetes across the UK were disappointing. The National Diabetes Audit has repeatedly demonstrated that, for England and Wales, people with type 1 diabetes are less likely to receive the nine care processes and less likely to achieve treatment targets than people with type 2 diabetes. 1 It has also found a worrying sevenfold increase in mortality in young women with type 1 diabetes. 2 The reasons behind these observations are multiple and complex, but specialist diabetes teams and primary care teams should work together to increase accessibility and encourage patient engagement, as all too often patients seem unwilling to attend the care that is on offer in any setting. All is not gloom: improvements in achievement of care processes and treatment targets in children in England have followed the introduction of a national paediatric diabetes network and a best practice tariff for children and adolescents with type 1 diabetes. 3 The Scottish Diabetes Surveys have shown improvements in the diabetes control for people with type 1 diabetes, and the national investment in insulin pump therapy is likely to accelerate this. 4 ABCD produced a position statement, updated in 2017, on the standards of care for the management of adults with type 1 Chair of ABCD Type 1 Diabetes Clinical Collaborative-UK