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.