Advanced glycation end products in children and adolescents with diabetes:Relation to glycemic control and early microvascular complications

Objective: The measurement of serum advanced glycation end products (S-AGEs ) in children, adolescents, and young adults with diabetes to determine whe ther increased S-AGE levels may be associated with long-term glycemic contr ol and early microvascular complications. Study design: The study was performed in (1) 178 children and adolescents w ith type 1 diabetes mellitus (age range, 2 to 21 years, onset before the ag e of 12 years; duration longer than 2 years) without clinical and laborator y signs of microvascular complications, (2) 39 adolescents and young adults (age range, 16.1 to 28.8 years) with background or preproliferative retino pathy or persistent microalbuminuria, and (3) 98 healthy age- and sex-match ed control subjects. Results: S-AGEs were significantly increased in preschool and prepubertal c hildren with diabetes and were particularly elevated in pubertal subjects w ith diabetes compared with control subjects. S-AGEs were markedly in crease d in adolescents with early microvascular complications compared with both control subjects and diabetic patients without retinopathy or nephropathy. No correlation was found between S-AGEs and albumin excretion rate or blood pressure values. Glycated hemoglobulin values and S-AGEs were significantl y correlated (r = 0.32; P < .01). In children with poorly controlled diabet es (HbA(1)c >10%), long-term (2 years) improvement of glycemic control resu lted in a significant reduction of S-AGE levels in preschool and prepuberta l children, as well as in pubertal individuals. Conclusions: S-AGE concentrations may be elevated even in preschool and pre pubertal children with diabetes; this means that the risk of microvascular complications may be present at an early age. Improvement in glycemic contr ol may be associated with a significant decrease in S-AGEs.