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Ther Adv Endocrinol Metab. 2019 Jul 25;10:2042018819863226. doi: 10.1177/2042018819863226. eCollection 2019.

Management of diabetes complications in youth.

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Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Hawkesbury Road, and Hainsworth Street, Westmead, NSW, 2145, Australia.
Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, NSW, Australia.


Type 1 and type 2 diabetes are increasing in prevalence and diabetes complications are common. Diabetes complications are rarely studied in youth, despite the potential onset in childhood. Microvascular complications of diabetes include retinopathy, diabetic kidney disease or nephropathy, and neuropathy that may be somatic or autonomic. Macrovascular disease is the leading cause of death in patients with type 1 diabetes. Strict glycaemic control will reduce microvascular and macrovascular complications; however, they may still manifest in youth. This article discusses the diagnosis and treatment of complications that arise from type 1 and type 2 diabetes mellitus in youth. Screening for complications is paramount as early intervention improves outcome. Screening should commence from 11 years of age depending on the duration of type 1 diabetes or at diagnosis for patients with type 2 diabetes. Diabetic retinopathy may require invasive treatment such as laser therapy or intravitreal antivascular endothelial growth factor therapy to prevent future blindness. Hypertension and albuminuria may herald diabetic nephropathy and require management with angiotensin converting enzyme (ACE) inhibition. In addition to hypertension, dyslipidaemia must be treated to reduce macrovascular complications. Interventional trials aimed at examining the treatment of diabetes complications in youth are few. Statins, ACE inhibitors and metformin have been successfully trialled in adolescents with type 1 diabetes with positive effects on lipid profile, microalbuminuria and measures of vascular health. Although relatively rare, complications do occur in youth and further research into effective treatment for diabetes complications, particularly therapeutics in children in addition to prevention strategies is required.


adolescents; albuminuria; children; diabetes complications; diabetes mellitus; hypertension; metformin; nephropathy; retinopathy

Conflict of interest statement

Conflict of interest statement: L.E.G. has no interests to declare. K.C.D. receives research support from the Australian National Health and Medical Research Council and Diabetes Australia, and her institution has received research support from JDRF and Medtronic. She has received speaker fees from Eli Lilly.

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