DIABETIC MICROANGIOPATHY

Microvascular complications of diabetes include retinopathy, nephropat hy and neuropathy, The first signs of these complications may develop in children and adolescents, particularly if insulin treatment has bee n inadequate. The mechanisms by which diabetic microangiopathy develop are not known, but probably include genetic influences. Several bioch emical changes may interact, one important change being increased prot ein glycation. Important functional changes are increased organ blood flow, increased vascular permeability, abnormal blood viscosity and ab normal platelet and endothelial function. The structural hallmark of d iabetic microangiopathy is the thickening of the capillary basement me mbrane. These changes may lead to occlusive angiopathy and to tissue h ypoxia and damage. Screening for microangiopathy should start in child ren and adolescents after 5-y duration of the disease and 10 y of age. The screening should include retinal examination through a dilated pu pil or fundus photography, urinary albumin excretion rate, blood press ure measurement and neurological examination. Several intervention tri als have shown that near normoglycaemia may reduce the risk of microan giopathy. There is a curvilinear association between the risk of devel opment and progression of microangiopathy and mean blood glucose. Ther efore, optimal insulin treatment is important in children and adolesce nts.