Microvascular and Macrovascular Complications in Children and Adolescents with Type 1 Diabetes

Diabetes mellitus is a serious chronic disorder of childhood and represents a major public health problem. Type 1 diabetes is the predominant form of diabetes during childhood and adolescence, accounting for about 90% of cases, although the growing epidemic of obesity has been associated with an increasing number of cases of childhood-onset type 2 diabetes (Craig et al., 2009; Patterson et al., 2009). The global incidence of type 1 diabetes is increasing worldwide, at an annual rate of 3-5%, particularly in children under the age of 5 years, and this trend leads to a significant health burden (Patterson et al., 2009). Recent studies have shown that in European countries childhood-onset type 1 diabetes is associated with three to four fold increased mortality when compared with the general population (Asao et al., 2003; Skrivarhaug et al., 2006). Similar data emerged from a long-term study of a young cohort with type 1 diabetes in the USA, where mortality was 7 times higher than in the non-diabetic population (Secrest et al., 2010a). The high mortality reported for individuals with type 1 diabetes is mainly due to diabetes-related acute and chronic complications. As recently emerged from a large population-based cohort with long-standing childhood-onset type 1 diabetes, during the first decade of diabetes acute complications, such as diabetic ketoacidosis and hypoglycemia, are the main causes of death, being responsible for about 73% of cases, whereas during subsequent decades cardiovascular (CVD) and renal diseases become the main determinants of mortality (Secrest et al., 2010b). Diabetes vascular complications are divided in microand macrovascular disease. Microvascular complications include nephropathy (DN), retinopathy (DR) and neuropathy, whereas macrovascualar complications refer to cardiovascular, cerebrovascular and peripheral vascular disease (Marshall and Flyvbjerg, 2006). As a result of vascular complications, diabetes is the leading cause of blindness in working age people, is responsible for up to 40% cases of renal failure and is a major determinant of cardiovascular morbidity and mortality (Marshall and Flyvbjerg, 2006).