ISRCTN66716753.

Background/Objective: Blood pressure abnormalities may play an important role in macrovascular damage in type 1 diabetes. Little is known about blood pressure abnormalities and macrovascular damage in children with type 1 diabetes.Methods: Children with type 1 diabetes (n = 57) for a short (3 months-2 years; n = 24) or long duration (≥5 years; n = 33) and a group of control children without diabetes (n = 29) completed 24-h ambulatory blood pressure monitoring (ABPM).Carotid intima media thickness (cIMT), a subclinical indicator of atherosclerosis, was assessed by carotid ultrasound.Results: ABPM abnormalities were more prevalent (57% vs 24%, respectively), and daytime, nighttime and 24-h systolic, diastolic, and mean arterial blood pressure indices were higher in children with type 1 diabetes compared to control children. The odds estimate of an ABPM abnormality was 6.68 (95% confidence interval: 1.95, 22.9; P = .003) in children with type 1 diabetes compared to controls after adjusting for age, sex, and BMI standardized for age and sex (zBMI). An interaction between ABPM and zBMI on cIMT was observed. In children with type 1 diabetes and ABPM abnormalities, every 1 SD increase in zBMI was associated with a 0.030 mm increase in cIMT (95% confidence interval: 0.002, 0.041; P = .031). This was not observed in control children with ABPM abnormalities or in children with normal ABPM, regardless of type 1 diabetes status.Conclusions: Children with type 1 diabetes have a high prevalence of ABPM abnormalities independent of disease duration and this is related to early indicators of cardiovascular damage. K E Y W O R D Sambulatory blood pressure monitoring, BMI, carotid-intima media thickness, children, type 1 diabetes

Key MessagesPublished data do not support the view that young age is a risk factor for cerebral edema development in children with diabetic ketoacidosis at the time of diagnosis. Younger children are at a higher risk for the development of diabetic ketoacidosis, in particular during the first 2 to 3 years of life. Whether diabetic ketoacidosis is more severe in younger children remains unclear. Keywords:cerebral edema children diabetic ketoacidosis review type 1 diabetes younger age a b s t r a c t Cerebral edema (CE) is a rare but potentially fatal complication of diabetic ketoacidosis (DKA) in children with type 1 diabetes. CE is frequently mentioned as being more common in young children. The primary objective of this study was to review the evidence suggesting that younger age is a risk factor for the development of CE during DKA. The secondary objective was to assess if younger children are at a higher risk of DKA and severe DKA. A literature review was performed, and studies which reported the frequency of CE, DKA and severe DKA in children <3 and 3 to 5 years of age were included. Among the 6 studies reporting the frequency of CE that were identified, 5 good-quality studies found no significant association between younger age and higher risk of CE. Twenty-seven studies (DKA frequency: 11.3% to 54%) reported DKA frequency as a function of age. Most published studies found a higher frequency of DKA in children <5 years of age (20/25 studies), and in particular in those in the first 2 to 3 years of life (8/8 studies). There was inconclusive evidence to determine whether the severity of DKA was influenced by age. In conclusion, the commonly held view that CE is more common in younger children is not supported by the existing literature. Published data suggest that DKA (and possibly severe DKA) is more common in very young children. Regardless of age, all children with DKA should be monitored carefully for the development of CE.Ó 2019 Canadian Diabetes Association.Mots clés: oedème cérébral enfants acidocétose diabétique revue diabète de type 1 de plus bas âge r é s u m é L'oedème cérébral (OC) est une complication rare, mais potentiellement fatale de l'acidocétose diabétique (ACD) chez les enfants atteints du diabète de type 1. On mentionne souvent que l'OC est plus fréquent chez les jeunes enfants. L'objectif principal de la présente étude était d'examiner les données probantes qui montrent que les enfants de plus bas âge qui sont atteints d'ACD sont exposés au risque de développer un OC. L'objectif secondaire était d'évaluer si les enfants de plus bas âge sont exposés à un risque plus élevé d'ACD et d'ACD grave. Dans la revue de littérature réalisée, nous avons sélectionné les études qui rapportaient la fréquence de l'OC, l'ACD et l'ACD grave chez les enfants âgés de < 3 ans et de 3