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

2. Type 1 DM in Adolescents
The Diabetes Control and Complications Trial (DCCT)
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.

3. 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.

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

5. Methods Subjects: Inclusion criteria: Complications assessment
1604 patients with type 1 DM evaluated between
Inclusion criteria:
Age 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.

6. Results

7. No change

10. 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.