The scleroderma-like syndrome (SLS) of diabetes consists of limited joint mobility and digital sclerosis. It is described in 8-50% of insulin-dependent diabetes mellitus patients and is the earliest clinically apparent long-term complication of diabetes in children and adolescents. The frequency of this finding appears to be related to the duration of diabetes and increasing age. Less clear are the relationships between this syndrome and glycaemic control or genetic factors. SLS is an easily identifiable marker for those young patients who may be at increased risk for the development of early microvascular complications. Recognition of this characterization will permit the clinician to focus on newer and improved techniques for long-term physiological control of the diabetes, in an attempt to prevent microvascular disease.