Vascular complications

Microvascular complications

• Children and adolescents with diabetes are at risk from progressive microvascular damage
• Early vascular changes are subclinical but can be detected by sensitive testing methods
• The prepubertal phase of diabetes contributes to the risk of vascular damage
• Puberty accelerates the progression of microvascular complications
• Improvements in glycemic control reduce the risk of retinopathy, nephropathy and neuropathy

Risk factors for the development of microvascular complications

• Younger age at onset
• Longer duration of diabetes
• Poor glycemic control
• Family history of diabetes complications
• Higher blood pressure (not necessarily to hypertensive levels)
• Smoking
• Abnormal lipid levels

Awareness in families, children and adolescents of potential long-term complications is a fundamental part of diabetes education. Such information should be provided to children at a rate appropriate to their level of understanding and maturity

Positive encouragement should be provided to emphasize that

• From the onset of diabetes the aim is to achieve the best possible metabolic control to reduce the risk of blood vessel complications
• Any level of sustained improvement in glycemic control reduces the risk of microvascular complications
• The DCCT found that for every 10% improvement in HbA_1c (e.g. 8 vs 7.2%)there is a 44% reduction of risk