Youth with diabetes have specific needs that benefit most from a dedicated diabetes clinic setting. The international experience suggests loss to follow up is of the order of 50% at two years post transition from paediatric services and DKA admission rates are between 5-15 per 100 patient years in the adolescent and young adult years. In 2002, a youth specific young adult diabetes clinic was implemented at Westmead primarily to reduce loss to follow up and prevent admission with DKA, however the service has had manifold benefits, beyond what was originally envisaged. Increased retention of young people in clinics means the service now serves 10 times the number of youth with diabetes. DKA admission rates have been reduced to 25% of baseline (<5 per 100 patient years) and loss to follow up occurs in only 5%. Within the last 12 months 90% have had at least one appointment. This has resulted in maintenance of diabetes control subsequent to transition and in those with the highest HbA1c significant improvements in control. Achieving such outcomes requires the transition team to have a unified approach to care which is focused on the specific needs of youth with chronic illness. This requires an understanding of the different stages of young adult development and receptiveness to change at each stage . Prospective data collection since the inception of the service has allowed evaluation of many aspects of care for youth with diabetes informing continued improvements to service delivery.