Prevention of microvascular complications in diabetic children and adolescents

Diabetes mellitus causes profound alterations in many body tissues. Microva scular diabetic complications include diabetic neuropathy, nephropathy and retinopathy. Nephropathy first becomes manifest with hyperfiltration and mi croalbuminuria. These functional changes evolve over several years to a sta ge of marked deterioration of renal function. The possible preventive measu res are metabolic control, reduction of dietary protein intake and use of A CE-inhibitors. Metabolic control is also important for the prevention of di abetic retinopathy. In fact, patients with HbA1c higher than 10% have an in creased risk of progression of retinopathy. Moreover, an accelerated progre ssion of retinopathy has been observed in patients with systemic hypertensi on following the onset of microalbuminuria. It has been demonstrated that d iabetic neuropathy can also be present during childhood; therefore, it is p ossible to detect electrophysiological abnormalities in children and adoles cents with IDDM. Glycaemic and blood pressure control are, so far, the main means for possible prevention or modification of the natural history of di abetic microvascular complications. Tight glycaemic control may have benefi cial effects for diabetic neuropathy. In addition, other preventive measure s, such as aldose reductase inhibitors, gangliosides, neurotrophic vitamins , etc., have been studied in the last years. However, no conclusive results have been obtained so far.