The IDF Diabetes Atlas, 5th edition, estimates that worldwide 495,100 children below 15 years of age are living with diabetes. Added to this number would be as many or more young people aged between 15 and 25 years. Together with adults with type 1 diabetes, these 1 million plus children and young people face the challenge of living with a complex, life-threatening chronic disease, but in widely different circumstances. The authors reflect on the latest figures from around the world for type 1 diabetes in young people, describe some of the challenges to providing universal care and treatment, and delivergood news about some positive trends in the developing world.