Diabetes Journal Club Carina Signori 1/19/2012 -- Diabetes Journal Club Carina Signori 1/19/2012

Type 1 DM in Adolescents The Diabetes Control and Complications Trial (DCCT)-- 1994 Prevalence of retinopathy in adolescents 41-46%. Microalbuminuria ranged between 4-20%. Intensive glucose management was associated with reduced microvascular complications in adults and adolescents. Post DCCT Intensive glucose management was recommended but difficult to obtain in young people. Yet, the authors reported a reduction in retinopathy and borderline elevation of albumin excretion rate (AER)/albumin-to-creatinine ratio (ACR). Microabluminuria declined then plateaued.

Type I DM in Children The association between intensive treatment regimens (continuous SQ infusion or MDI) and improved glycemic control has not been clearly established. No evidence showing reduced risk of complications in children treated with CSQI or MDI versus 1-2 injections/day.

Aim Examine trends in the prevalence of microvascular complications from 1990-2009. Association of time period and complications. Association of risk factors, socioeconmic factors and treatment regimens.

Methods Subjects: Inclusion criteria: Complications assessment 1604 patients with type 1 DM evaluated between1990- 2009. Inclusion criteria: Age 12-20 years Diabetes for ≥5 years. Complications assessment Retinopathy – eye exam Microalbuminuria: ↑AER/ACR,↑ microalbuminuria Peripheral nerve function– thermal and vibration thresthold testing. Glycemic control: GHb colorimetrically (before 2/1994) then hemoglobin A1C.

Results

No change

Conclusions This study looked at the microvascular complications in the adolescent population with type 1 DM. Retinopathy prevalence decreased in parallel with HbA1C. Microalbuminuria and peripheral nerve abnormalities plateaued. Severe hypoglycemia remained unchanged. This suggests that lower glycemic targets and intensive insulin may be beneficial in children and adolescents.