DIABETIC ANGIOPATHY IN CHILDREN

Among the secondary complications of diabetes, early stages of retinop athy and nephropathy are of foremost importance in paediatrics. Regula r examinations of retinal status and of urinary albumin excretion ther efore become necessary with the onset of puberty or after 5 years of d iabetes duration. With fluorescein angiography, the first retinal chan ges can be expected after a median diabetes duration of 9 years, while the median time to clinically relevant background retinopathy is 14 y ears. This diagnosis is delayed by 4 and 6 years, respectively, if ret inopathy is staged exclusively by ophthalmoscopy. Approximately 10 to 20 % of children may develop microalbuminuria, starting in early puber ty. Several risk factors for the development of diabetic angiopathy ha ve been identified. The degree of glycaemic control, both before and a fter puberty, appears to be of outstanding importance, but the contrib ution of other factors may be of varying relevance in the individual p atient. These include arterial blood pressure, lipid abnormalities, se x steroids, smoking and genetic factors. Apart from the best possible metabolic regulation, early treatment with antihypertensive drugs has been shown to be beneficial in hypertensive adolescents but may also b e renoprotective in normotensive adolescents with permanent microalbum inuria. However, the relatively high prevalence of intermittent and tr ansient microalbuminuria in paediatric patients (2 and 3 % respectivel y), with unknown prognostic relevance, complicate the decision to star t such treatment for a lifetime. Nevertheless, the early detection of risk factors and the implementation of appropriate intervention strate gies are necessary to improve the long-term prognosis for children wit h diabetes. (C) 1997 by John Wiley & Sons, Ltd.