Complications of Diabetes in Children: When Does the Clock Start Running?

Abstract

Pediatricians are frequently accused of not being properly concerned about the complications of diabetes in children. This statement is commonly made by physicians who inherit the care of the young adults who have complications secondary to diabetes with onset during childhood. Since these complications rarely become manifest during childhood or adolescence, it is alleged that pediatricians fail to understand the importance of good diabetic control for their prevention. The “complications” considered in this context are diabetic retinopathy, nephropathy, neuropathy, macrovascular disease leading to coronary artery disease, and peripheral vascular insufficiency which results in lower limb amputations. These problems tend to become clinically evident a number of years after the initial diagnosis of diabetes mellitus.

It is rare to recognize diabetic retinopathy before diabetes has been present for at least 5 years. Diabetic nephropathy is first recognized when the patient develops hypertension or protein in the urine. This generally requires 10 years of clinically recognized diabetes mellitus. If one considers that the prepubertal age for peak incidence of new cases of insulin-dependent diabetes mellitus (IDDM) is 5 to 6 years of age, it is easy to understand why pediatricians are rarely involved in managing the complications of IDDM. If one includes adolescents in pediatric practice (not a universal practice), it is found that the greatest number of youth have the onset of IDDM with the onset of puberty. Therefore, the associated complications will have their earliest recognition 5 to 10 years later.