Adolescent prevention of complications

Abstract

The prognosis for childhood-onset type 1 diabetes remains poor, and, despite improvements in management, many patients will experience long-term microvascular and macrovascular complications. Although clinically evident vascular complications are rarely diagnosed among children, there is clear evidence that early signs, such as increased albumin excretion and microalbuminuria, emerge during puberty.Adolescence is a critical period, as glycaemic control invariably deteriorates, and puberty is an independent risk factor for vascular complications. Additional risk factors for microalbuminuria during adolescence are dyslipidaemia, high blood pressure, abnormalities in the growth hormone-insulin-like growth factor axis, inflammatory markers and early signs of atherosclerosis.Glycaemic control remains the principle modifiable risk factor associated with microalbuminuria, and, at present, achieving a good glycaemic control is the main primary prevention and treatment strategy in adolescents with type 1 diabetes and microalbuminuria. Over the next years, ongoing and future studies will allow a better understanding of the potential beneficial effect of other cardio-renal interventions (such as ACE inhibitors, statins) in adolescents with type 1 diabetes and increased albumin excretion.