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

Abstract

The incidence of type 1 diabetes (T1D) is increasing worldwide and is associated with a significant burden, mainly related to the development of vascular complications. Over the last decades, concomitant with the epidemic of childhood obesity, there has been an increasing number of cases of type 2 diabetes (T2D) among children and adolescents. Microvascular complications of diabetes, which include nephropathy, retinopathy and neuropathy, are characterized by damage to the microvasculature of the kidney, retina and neurons. Although clinically evident microvascular complications are rarely seen among children and adolescents with diabetes, there is clear evidence that their pathogenesis and early signs develop during childhood and accelerate during puberty. Diabetic vascular complications are often asymptomatic during their early stages, and once symptoms develop, there is little to be done to cure them. Therefore, screening needs to be started early during adolescence and, in the case of T2D, already at diagnosis. Identification of risk factors and subclinical signs of complications is essential for the early implementation of preventive and therapeutic strategies, which could change the course of vascular complications and improve the prognosis of children, adolescents and young adults with diabetes.

Tumor Necrosis Factor/Sphingosine-1-Phosphate Signaling Augments Resistance Artery Myogenic Tone in Diabetes

“…Supporting this premise, the present investigation identifies two vascular beds that are highly sensitive to impaired glucose control. Although the observed functional changes do not overtly perturb systemic hemodynamics or cerebral perfusion, they should not be underestimated: microvascular complications in diabetes are often asymptomatic during their early stages; once symptoms develop, they are generally difficult to reverse or clinically manage (32)(33)(34). Consequently, silent or asymptomatic microcirculatory dysfunction is now viewed as a key intervention point that can potentially alter the patient's clinical course.…”

Early signs of diabetic nephropathy and ultrasound characteristics of kidneys in children and youth with diabetes mellitus type 1

“…Inadequate metabolic control directly correlated with kidney hyperfiltration and hyperperfusion. It presents one of the major risk factors for occurrence of AER among children and youth with DMT1 (15,16).…”

“…High levels of HbA1C as a marker of chronic hyperglycemia are the most commonly determined risk factor for appearance of AER and development of DN in children and youth with DMT1 (16). Elevated values of systolic and diastolic blood pressure, according to some authors, appear independently from AER (16,17,18).…”

Money as Health: A Study of Health Status Disparities among African Americans of Flint, Michigan

“…Recent research has indicated that, with each 1 microgram per deciliter increase in blood lead level, children demonstrate decreasing performance on intelligence tests. (p. 23) Historically, African Americans have experienced and do experience racism. The impact of both overt and covert racism on African Americans has been well documented in literature.…”

“…There is a valid basis for advocating positive, health-related choices that can change the prevalence rate of certain morbid conditions in varying populations. For example, teaching adolescents how to incorporate regular physical activities as a weekly routine may result in a corresponding decrease in the prevalence rate of obesity, and consequently reduce the risks of diabetes mellitus [23].…”