F Chiarelli, D Di Marzio

Abstract

Objective: To review currently available evidence on the molecular mechanisms, risk factors and outcomes of mico- and macrovascular complications in children with type 1 diabetes mellitus. Data sources and study selection: Medline, Pubmed, and Cochrane Library searches of internationally published English language journals, from 1985 to February 2010 using the terms "diabetes", "children", "complications", "angiopathy" and "management". Data extraction: All articles involving diabetes vascular complications in children were included in the review. Data synthesis: During the natural history of diabetes several molecular, receptorial and cellular factors provide a continuous mechanism of vascular damage. In children with diabetes this state is present at an early age so that accelerated atherosclerosis is associated with an increased risk of micro- and macrovascular complications as compared to the non-diabetic paediatric population. The major long term complications of diabetes can be divided into micro- (nephropathy, retinopathy and neuropathy) and macrovascular complications. Childhood remains a period during which intensive education and treatment may prevent or delay the onset and progression of these complications. Conclusions: Although the prognosis has improved considerably in recent years due to the advances in the therapeutic interventions, systematic regular screening continues to have a pivotal role in the management of complications in diabetic children. Primary prevention to all risk factors for vascular complications is essential and intervention is indicated if necessary even in childhood.