Complications of diabetes mellitus in children

Diabetic angiopathies are the main cause of disability in patients with diabetes mellitus type 1 and develop with chronic hyperglycemia and have common morphological features: aneurysmal changes in capillaries, thickening of the walls of arterioles, capillaries and venules due to the accumulation of glycoproteins and neutral mucopolysaccharides in the basement membrane, proliferation of the endothelium and its desquamation into the lumen of the vessels, leading to their obliteration.

Diabetic retinopathy is a cause of blindness in the absence of high-quality long-term glycemic control. There are three stages of its development.

• Stage I. Non-proliferative retinopathy: microaneurysms, hemorrhages, edema, exudative foci in the retina.
• Stage II. Preproliferative retinopathy - venous anomalies, a large number of hard and "cotton-like" exudates, numerous large retinal hemorrhages.
• Stage III. Proliferative retinopathy - the formation of new vessels, the rupture of which can lead to hemorrhage and retinal detachment.

The initial stages of retinopathy may not progress for many years (up to 20 years). Factors leading to proliferative retinopathy are the duration of the disease with poor metabolic control, high blood pressure and genetic predisposition. In this regard, an examination of the fundus should be performed by an ophthalmologist using ophthalmoscopy, stereo photography of the fundus or fluorescein angiography annually.

The most effective method of treating diabetic retinopathy is laser coagulation.

Diabetic nephropathy is a primarily chronic process, manifested initially by hypertrophy and hyperfiltration of nephrons, then by microalbuminuria against the background of normal filtration and, finally, by progressive glomerulosclerosis with the gradual development of chronic renal failure.

The clinically expressed stage of nephropathy is always preceded by years of transient or permanent microalbuminuria - albumin excretion rate from 20 to 200 mcg/min or from 30 to 300 mg/day. To determine the albumin excretion rate, it is advisable to use the collection of a night portion of urine, when the effects of physical activity, orthostasis, and fluctuations in blood pressure are excluded. It is necessary to remember that a number of factors lead to a false-positive result (glomerulonephritis, urinary tract infections, intense physical activity, menstrual bleeding). Screening for the albumin excretion rate should be performed annually. If microalbuminuria remains constant or progresses (despite improved glucose control and the absence of arterial hypertension), ACE inhibitors should be prescribed.

Diabetic neuropathy in children and adolescents occurs in the form of distal symmetrical sensory-motor polyneuropathy. It is characterized by symmetrical damage to the sensory and motor nerve fibers of the distal lower extremities. The main manifestations of neuropathy in children are pain syndrome, paresthesia, and decreased tendon reflexes. Less common are disturbances of tactile, temperature, pain, and vibration sensitivity.

Limited joint mobility and stiffness of the hands and fingers are frequently observed in children with type 1 diabetes mellitus and are associated with the development of angiopathy in the presence of poor metabolic control.

Lipoid necrobiosis - round, pink skin lesions of unknown etiology. Rarely seen in children.

The main method of prevention and simultaneous treatment of chronic complications of diabetes mellitus is achieving and maintaining compensation of metabolic disorders with constant glycemic control.

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