Early microvascular complications in type 1 and type 2 diabetes: recent developments and updates

The prevalence of youth-onset diabetes is progressing rapidly worldwide, and poor glycemic control, in combination with prolonged diabetes duration and comorbidities including hypertension, has led to the early development of microvascular complications including diabetic kidney disease, retinopathy...

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Published in:Pediatric nephrology (Berlin, West) West), 2022-01, Vol.37 (1), p.79-93
Main Authors: Tommerdahl, Kalie L., Shapiro, Allison L. B., Nehus, Edward J., Bjornstad, Petter
Format: Article
Language:English
Subjects:
Adolescent
Diabetes
Diabetes mellitus (insulin dependent)
Diabetes mellitus (non-insulin dependent)
Diabetes Mellitus, Type 1 - complications
Diabetes Mellitus, Type 2 - complications
Diabetic Nephropathies - epidemiology
Diabetic Neuropathies - epidemiology
Diabetic neuropathy
Diabetic Retinopathy - epidemiology
Educational Review
Epidemiology
Humans
Kidney diseases
Medicine
Medicine & Public Health
Microvasculature
Morbidity
Nephrology
Oxidation
Pediatrics
Retinopathy
Risk Factors
Teenagers
Urology
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Summary:The prevalence of youth-onset diabetes is progressing rapidly worldwide, and poor glycemic control, in combination with prolonged diabetes duration and comorbidities including hypertension, has led to the early development of microvascular complications including diabetic kidney disease, retinopathy, and neuropathy. Pediatric populations with type 1 (T1D) and type 2 (T2D) diabetes are classically underdiagnosed with microvascular complications, and this leads to both undertreatment and insufficient attention to the mitigation of risk factors that could help attenuate further progression of complications and decrease the likelihood for long-term morbidity and mortality. This narrative review aims to present a comprehensive summary of the epidemiology, risk factors, symptoms, screening practices, and treatment options, including future opportunities for treatment advancement, for microvascular complications in youth with T1D and T2D. We seek to uniquely focus on the inherent challenges of managing pediatric populations with diabetes and discuss the similarities and differences between microvascular complications in T1D and T2D, while presenting a strong emphasis on the importance of early identification of at-risk youth. Further investigation of possible treatment mechanisms for microvascular complications in youth with T1D and T2D through dedicated pediatric outcome trials is necessary to target the brief window where early pathological vascular changes may be significantly attenuated.
ISSN:0931-041X
1432-198X
DOI:10.1007/s00467-021-05050-7