Prevalence of microvascular and neurologic abnormalities in a population of diabetic children

One hundred and twenty-nine (87%) of a total county population of 150 eligi ble diabetic children together with 144 age- and sex-matched control childr en participated in a longitudinal, epidemiological study of the evolution o f diabetic microvascular disease, At enrollment the median (range) age of t he diabetic children was 12.5 (3.7-16.8) years with a median diabetes durat ion of 2.9 (0.1-13.4) years and a median HbA(1) of 11.1 (6.8-17.9)%. Two se ts of measurements were made over a period of 18 months for all indices of microvascular disease, while autonomic function was studied on one occasion , Urinary albumin excretion in diabetic children was assessed from all void ings during two timed 48-h urine collections and was expressed as urinary a lbumin/creatinine ratios (ACR), Blood pressure (BP) was measured using a ra ndom zero sphygmomanometer, Autonomic function was assessed by pupillary ad aptation in darkness, using a portable Polaroid pupillometer, and by heart rate (HR) variation recorded by dedicated computer, Vibration sensation thr esholds (VST) (as indices of peripheral neuropathy) were recorded using a B iothesiometer, Limited joint mobility (LJM) was assessed by the "prayer sig n", Five (3.9%) diabetic children presented raised mean ACR in more than tw o of four 24-h urine collections, Fourteen (10.8%) diabetic children were i dentified as having persistently raised BP during both study periods, Impai red HR response in one HR test was observed in 20 (15.5%) diabetic children , while ten (7.7%) diabetic children demonstrated abnormalities in two or m ore HR tests, Reduced pupillary adaptation in darkness was found in eight ( 7.9%) diabetic children, Persistent vibration sensation impairment (VST) in lower limbs was detected in eight (6.2%) diabetic children, while LJM was present in 12 (9.3%) diabetic children, Eight of the 129 diabetic children (6.2%) were found to have abnormality in two and one in three indices of mi crovascular and autonomic function, Six of nine children had coexistence of impaired autonomic neuropathy and nephropathy, These nine children were di agnosed at a younger age than the rest of the diabetic population (5.1 vs 8 .0 yr, p = 0.002), Four of nine were aged greater than or equal to 11 yr an d five of nine had had diabetes for greater than or equal to 5 yr, Thus, a constellation of microvascular and neurological abnormalities were demonstr able in a small proportion of diabetic children, who were younger than the rest of the population at the time of onset of their disease, Longitudinal study of this population will demonstrate the clinical significance of thes e findings.