Early Diabetes-Related Complications in Adolescents

Abstract

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.

Risk Factors for Renal Injury in Children With a Solitary Functioning Kidney

“…As reported in patients with diabetes, 21 we expected renal injury to occur in the second decade after the onset of glomerular hyperfiltration. Surprisingly, our results illustrate that patients show signs of renal injury during the full age range of childhood.…”

Microvascular disease in children and adolescents with type 1 diabetes and obesity

“…In people with childhood-onset T1D, MA is often detected during puberty [7], with a cumulative prevalence of around 10-25% after 5-10 years of diabetes duration [24][25][26] and up to 50% after 19 years of diabetes duration [26]. This is significantly higher than the prevalence of 34% reported in adult cohorts after a similar diabetes duration and exposure to similar levels of glycemic control [15].…”

“…Microvascular complications are virtually always subclinical during childhood and adolescence, and advanced stages are extremely rare [7]. However, early signs of microvascular disease, such as increases in albumin excretion rates and glomerular filtration rate (GFR), renal hypertrophy, changes in the retinal microvasculature and impaired autonomic nervous system function, are detectable early during the course of childhood-onset diabetes and often accelerate during puberty.…”

Renal function in diabetic nephropathy

“…Nephropathy is the leading cause of chronic renal failure worldwide and is responsible for renal failure in about one third of patients who undergo dialysis. It is suggested that patients with common risk factors including greater duration of diabetes, hypertension, poor metabolic control, smoking, obesity and hyperlipidemia are more prone to develop diabetic complications [7] . In a retrospective study done by Klag et al [8] it was found that elevations of blood pressure are a strong independent risk factor for endstage renal disease and that interventions to prevent the disease need to emphasize the prevention and control of both highnormal and high blood pressure.…”