Micro- and macrovascular complications account for the major part of the morbidity and mortality associated with diabetes developing in childhood. Although advanced complications are exceptionally rare in the adolescent age group, it is during this phase that the progression of risk may accelerate. A number of potentially important factors have been identified which might contribute to risk of complication development: some provide insights into the genetics of these complications, while others are potentially modifiable, such as metabolic control, hypertension, smoking, obesity and hyperlipidemia. Recently, both consensus and evidence-based guidelines have been developed to guide those involved in the care of adolescents with diabetes in the prevention, screening and management of early diabetes-related complications in this vulnerable population. This article reviews the literature that underpins the available guidelines and stresses the pivotal role of excellent metabolic control in complication prevention.