Prevention of secondary complications of diabetes

Among the secondary complications of diabetes, early stages of retinopathy and nephropathy are of foremost importance in pediatrics. Therefore, period ic examinations of the retinal status and of the urinary albumin excretion become necessary with the onset of puberty or after 5 years of diabetes dur ation. Risk factors for the development of diabetic angiopathy are the degree of g lycaemic control, both, before and after puberty, arterial blood pressure, lipid abnormalities, sex steroids, smoking and genetic components. Age-appropriate individualized information on the risk for late complicatio ns is necessary in the counseling of adolescents, parents and caregivers to decrease unwarranted fear and to empower families for a motivated diabetes therapy. Increasing evidence points to the importance of initiating good d iabetes treatment already in the first year of diabetes for the long term p rognosis. Thus pediatricians have to join forces to enable all children wit h diabetes to have access to experienced multiprofessional pediatric diabet es care from the onset of the disease.