From Michigan, USA:
In a previous question, you noted that there is no evidence that tight control in young children is required and it is often stated that the microvascular complications of diabetes do not occur in prepubertal children.
Is there strong data to support such a statement? By the time my child reaches puberty he will have had diabetes for 10-12 years. Is it really true that this duration of disease will not produce microvascular changes before puberty when such changes would be invariable for the same duration of disease after puberty. Has this area been sufficiently stated or is it based on anecdotal experience?
Surprisingly, there was very little evidence that control was related to complications in any age group until the completion of the DCCT trial which showed that in adults there was a clear relationship between poor control and microvascular complications and vice versa. In young diabetics, several authorities still maintained that there was no such relationship before puberty. There was one study about seven years ago in 200+ children aged less than a year to over 18. It was a retrospective statistical exercise which assessed A1c levels against the incidence of microalbuminuria and graded retinal changes either from onset to age 15 or from onset to ten years later. The study had significant shortcomings; but it dispelled the earlier notion that control before puberty was not all that important. The incidence and the degree of microvascular involvement was significantly correlated with the time the A1c levels were greater than the upper level of normal for the method + 10%. It is still true that microalbuminuria and retinal changes are very rare before age 15 and in the study described above there was no effort made to look at different age groups separately so there is still no evidence that very young diabetics are protected or otherwise.
Original posting 22 Dec 96
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