UpToDate
Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Complications and screening in children and adolescents with type 1 diabetes mellitus

Authors
Lynne L Levitsky, MD
Madhusmita Misra, MD, MPH
Section Editor
Joseph I Wolfsdorf, MB, BCh
Deputy Editor
Alison G Hoppin, MD

INTRODUCTION

Type 1 diabetes mellitus (T1DM), one of the most common chronic diseases in childhood, is caused by insulin deficiency resulting from the destruction of insulin-producing pancreatic beta cells. (See "Pathogenesis of type 1 diabetes mellitus".)

In children and adolescents with T1DM, the most common complications include hypoglycemia, hyperglycemia, diabetic ketoacidosis (DKA), and psychiatric disorders. The pathogenesis of long-term vascular sequelae including retinopathy, nephropathy, neuropathy, and cardiovascular disease begins in childhood, although clinical manifestations of these complications are uncommon before adulthood. Vascular complications and mortality during adulthood are discussed in a separate topic review. (See "Glycemic control and vascular complications in type 1 diabetes mellitus".)

The chronic complications of T1DM that occur in childhood will be presented here. Other issues related to the management of T1DM in children are discussed separately:

(See "Epidemiology, presentation, and diagnosis of type 1 diabetes mellitus in children and adolescents".)

(See "Management of type 1 diabetes mellitus in children and adolescents".)

                                

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Nov 2016. | This topic last updated: Wed Feb 24 00:00:00 GMT+00:00 2016.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
References
Top
  1. Lipton R, Good G, Mikhailov T, et al. Ethnic differences in mortality from insulin-dependent diabetes mellitus among people less than 25 years of age. Pediatrics 1999; 103:952.
  2. Franzese A, Iorio R, Buono P, et al. Mauriac syndrome still exists. Diabetes Res Clin Pract 2001; 54:219.
  3. Elder CJ, Natarajan A. Mauriac syndrome--a modern reality. J Pediatr Endocrinol Metab 2010; 23:311.
  4. Kim MS, Quintos JB. Mauriac syndrome: growth failure and type 1 diabetes mellitus. Pediatr Endocrinol Rev 2008; 5 Suppl 4:989.
  5. Bua J, Marchetti F, Faleschini E, et al. Hepatic glycogenosis in an adolescent with diabetes. J Pediatr 2010; 157:1042.
  6. Fitzpatrick E, Cotoi C, Quaglia A, et al. Hepatopathy of Mauriac syndrome: a retrospective review from a tertiary liver centre. Arch Dis Child 2014; 99:354.
  7. Dorchy H, Van Vliet G. Cause of dwarfism in Mauriac syndrome. J Pediatr 1981; 98:857.
  8. Daneman D, Drash AL, Lobes LA, et al. Progressive retinopathy with improved control in diabetic dwarfism (Mauriac's syndrome). Diabetes Care 1981; 4:360.
  9. Chiang JL, Kirkman MS, Laffel LM, et al. Type 1 diabetes through the life span: a position statement of the American Diabetes Association. Diabetes Care 2014; 37:2034.
  10. American Diabetes Association. 11. Children and Adolescents. Diabetes Care 2016; 39 Suppl 1:S86.
  11. Grey M, Whittemore R, Tamborlane W. Depression in type 1 diabetes in children: natural history and correlates. J Psychosom Res 2002; 53:907.
  12. Kovacs M, Goldston D, Obrosky DS, Bonar LK. Psychiatric disorders in youths with IDDM: rates and risk factors. Diabetes Care 1997; 20:36.
  13. Kovacs M, Obrosky DS, Goldston D, Drash A. Major depressive disorder in youths with IDDM. A controlled prospective study of course and outcome. Diabetes Care 1997; 20:45.
  14. Stewart SM, Rao U, Emslie GJ, et al. Depressive symptoms predict hospitalization for adolescents with type 1 diabetes mellitus. Pediatrics 2005; 115:1315.
  15. Lawrence JM, Standiford DA, Loots B, et al. Prevalence and correlates of depressed mood among youth with diabetes: the SEARCH for Diabetes in Youth study. Pediatrics 2006; 117:1348.
  16. Silverstein J, Cheng P, Ruedy KJ, et al. Depressive Symptoms in Youth With Type 1 or Type 2 Diabetes: Results of the Pediatric Diabetes Consortium Screening Assessment of Depression in Diabetes Study. Diabetes Care 2015; 38:2341.
  17. Christiansen E, Stenager E. Risk for attempted suicide in children and youths after contact with somatic hospitals: a Danish register based nested case-control study. J Epidemiol Community Health 2012; 66:247.
  18. Svoren BM, Butler D, Levine BS, et al. Reducing acute adverse outcomes in youths with type 1 diabetes: a randomized, controlled trial. Pediatrics 2003; 112:914.
  19. Ellis DA, Frey MA, Naar-King S, et al. Use of multisystemic therapy to improve regimen adherence among adolescents with type 1 diabetes in chronic poor metabolic control: a randomized controlled trial. Diabetes Care 2005; 28:1604.
  20. Winkley K, Ismail K, Landau S, Eisler I. Psychological interventions to improve glycaemic control in patients with type 1 diabetes: systematic review and meta-analysis of randomised controlled trials. BMJ 2006; 333:65.
  21. Affenito SG, Adams CH. Are eating disorders more prevalent in females with type 1 diabetes mellitus when the impact of insulin omission is considered? Nutr Rev 2001; 59:179.
  22. Meltzer LJ, Johnson SB, Prine JM, et al. Disordered eating, body mass, and glycemic control in adolescents with type 1 diabetes. Diabetes Care 2001; 24:678.
  23. Mannucci E, Rotella F, Ricca V, et al. Eating disorders in patients with type 1 diabetes: a meta-analysis. J Endocrinol Invest 2005; 28:417.
  24. Colton P, Olmsted M, Daneman D, et al. Disturbed eating behavior and eating disorders in preteen and early teenage girls with type 1 diabetes: a case-controlled study. Diabetes Care 2004; 27:1654.
  25. Ackard DM, Vik N, Neumark-Sztainer D, et al. Disordered eating and body dissatisfaction in adolescents with type 1 diabetes and a population-based comparison sample: comparative prevalence and clinical implications. Pediatr Diabetes 2008; 9:312.
  26. Jones JM, Lawson ML, Daneman D, et al. Eating disorders in adolescent females with and without type 1 diabetes: cross sectional study. BMJ 2000; 320:1563.
  27. Cohn BA, Cirillo PM, Wingard DL, et al. Gender differences in hospitalizations for IDDM among adolescents in California, 1991. Implications for prevention. Diabetes Care 1997; 20:1677.
  28. Takii M, Uchigata Y, Tokunaga S, et al. The duration of severe insulin omission is the factor most closely associated with the microvascular complications of Type 1 diabetic females with clinical eating disorders. Int J Eat Disord 2008; 41:259.
  29. Nielsen S, Emborg C, Mølbak AG. Mortality in concurrent type 1 diabetes and anorexia nervosa. Diabetes Care 2002; 25:309.
  30. Urbina EM, Wadwa RP, Davis C, et al. Prevalence of increased arterial stiffness in children with type 1 diabetes mellitus differs by measurement site and sex: the SEARCH for Diabetes in Youth Study. J Pediatr 2010; 156:731.
  31. Maahs DM, Daniels SR, de Ferranti SD, et al. Cardiovascular disease risk factors in youth with diabetes mellitus: a scientific statement from the American Heart Association. Circulation 2014; 130:1532.
  32. Trigona B, Aggoun Y, Maggio A, et al. Preclinical noninvasive markers of atherosclerosis in children and adolescents with type 1 diabetes are influenced by physical activity. J Pediatr 2010; 157:533.
  33. Nordwall M, Bojestig M, Arnqvist HJ, et al. Declining incidence of severe retinopathy and persisting decrease of nephropathy in an unselected population of Type 1 diabetes-the Linköping Diabetes Complications Study. Diabetologia 2004; 47:1266.
  34. Pambianco G, Costacou T, Ellis D, et al. The 30-year natural history of type 1 diabetes complications: the Pittsburgh Epidemiology of Diabetes Complications Study experience. Diabetes 2006; 55:1463.
  35. Svensson M, Nyström L, Schön S, Dahlquist G. Age at onset of childhood-onset type 1 diabetes and the development of end-stage renal disease: a nationwide population-based study. Diabetes Care 2006; 29:538.
  36. Schultz CJ, Konopelska-Bahu T, Dalton RN, et al. Microalbuminuria prevalence varies with age, sex, and puberty in children with type 1 diabetes followed from diagnosis in a longitudinal study. Oxford Regional Prospective Study Group. Diabetes Care 1999; 22:495.
  37. Svensson M, Eriksson JW, Dahlquist G. Early glycemic control, age at onset, and development of microvascular complications in childhood-onset type 1 diabetes: a population-based study in northern Sweden. Diabetes Care 2004; 27:955.
  38. Bognetti E, Calori G, Meschi F, et al. Prevalence and correlations of early microvascular complications in young type I diabetic patients: role of puberty. J Pediatr Endocrinol Metab 1997; 10:587.
  39. Roe TF, Costin G, Kaufman FR, Carlson ME. Blood glucose control and albuminuria in type 1 diabetes mellitus. J Pediatr 1991; 119:178.
  40. Holl RW, Grabert M, Thon A, Heinze E. Urinary excretion of albumin in adolescents with type 1 diabetes: persistent versus intermittent microalbuminuria and relationship to duration of diabetes, sex, and metabolic control. Diabetes Care 1999; 22:1555.
  41. Amin R, Widmer B, Prevost AT, et al. Risk of microalbuminuria and progression to macroalbuminuria in a cohort with childhood onset type 1 diabetes: prospective observational study. BMJ 2008; 336:697.
  42. Holl RW, Grabert M, Heinze E, Debatin KM. Objective assessment of smoking habits by urinary cotinine measurement in adolescents and young adults with type 1 diabetes. Reliability of reported cigarette consumption and relationship to urinary albumin excretion. Diabetes Care 1998; 21:787.
  43. Harvey JN, Allagoa B. The long-term renal and retinal outcome of childhood-onset Type 1 diabetes. Diabet Med 2004; 21:26.
  44. Möllsten A, Svensson M, Waernbaum I, et al. Cumulative risk, age at onset, and sex-specific differences for developing end-stage renal disease in young patients with type 1 diabetes: a nationwide population-based cohort study. Diabetes 2010; 59:1803.
  45. Salardi S, Balsamo C, Zucchini S, et al. High rate of regression from micro-macroalbuminuria to normoalbuminuria in children and adolescents with type 1 diabetes treated or not with enalapril: the influence of HDL cholesterol. Diabetes Care 2011; 34:424.
  46. Theochari MA, Vyssoulis GP, Toutouzas PK, Bartsocas CS. Arterial blood pressure changes in children and adolescents with insulin-dependent diabetes mellitus. J Pediatr 1996; 129:667.
  47. Guntsche Z, Saraví FD, Reynals EA, et al. Parental hypertension and 24 h-blood pressure in children prior to diabetic nephropathy. Pediatr Nephrol 2002; 17:157.
  48. Rodriguez BL, Dabelea D, Liese AD, et al. Prevalence and correlates of elevated blood pressure in youth with diabetes mellitus: the SEARCH for diabetes in youth study. J Pediatr 2010; 157:245.
  49. Hilgers KF, Dötsch J, Rascher W, Mann JF. Treatment strategies in patients with chronic renal disease: ACE inhibitors, angiotensin receptor antagonists, or both? Pediatr Nephrol 2004; 19:956.
  50. Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents, National Heart, Lung, and Blood Institute. Expert panel on integrated guidelines for cardiovascular health and risk reduction in children and adolescents: summary report. Pediatrics 2011; 128 Suppl 5:S213.
  51. Danne T, Kordonouri O, Hövener G, Weber B. Diabetic angiopathy in children. Diabet Med 1997; 14:1012.
  52. Olsen BS, Johannesen J, Sjølie AK, et al. Metabolic control and prevalence of microvascular complications in young Danish patients with Type 1 diabetes mellitus. Danish Study Group of Diabetes in Childhood. Diabet Med 1999; 16:79.
  53. Holl RW, Lang GE, Grabert M, et al. Diabetic retinopathy in pediatric patients with type-1 diabetes: effect of diabetes duration, prepubertal and pubertal onset of diabetes, and metabolic control. J Pediatr 1998; 132:790.
  54. Danne T, Kordonouri O, Enders I, et al. Factors modifying the effect of hyperglycemia on the development of retinopathy in adolescents with diabetes. Results of the Berlin Retinopathy Study. Horm Res 1998; 50 Suppl 1:28.
  55. Danne T, Kordonouri O, Enders I, Hövener G. Monitoring for retinopathy in children and adolescents with type 1 diabetes. Acta Paediatr Suppl 1998; 425:35.
  56. Sasongko MB, Wang JJ, Donaghue KC, et al. Alterations in retinal microvascular geometry in young type 1 diabetes. Diabetes Care 2010; 33:1331.
  57. Verrotti A, Catino M, Di Ricco L, et al. Prevention of microvascular complications in diabetic children and adolescents. Acta Paediatr Suppl 1999; 88:35.
  58. Kordonouri O, Danne T, Hopfenmüller W, et al. Lipid profiles and blood pressure: are they risk factors for the development of early background retinopathy and incipient nephropathy in children with insulin-dependent diabetes mellitus? Acta Paediatr 1996; 85:43.
  59. Gallego PH, Craig ME, Hing S, Donaghue KC. Role of blood pressure in development of early retinopathy in adolescents with type 1 diabetes: prospective cohort study. BMJ 2008; 337:a918.
  60. Verrotti A, Lobefalo L, Chiarelli F, et al. Colour vision and persistent microalbuminuria in children with type-1 (insulin-dependent) diabetes mellitus: a longitudinal study. Diabetes Res Clin Pract 1995; 30:125.
  61. Karavanaki K, Baum JD. Coexistence of impaired indices of autonomic neuropathy and diabetic nephropathy in a cohort of children with type 1 diabetes mellitus. J Pediatr Endocrinol Metab 2003; 16:79.
  62. Massin MM, Derkenne B, Tallsund M, et al. Cardiac autonomic dysfunction in diabetic children. Diabetes Care 1999; 22:1845.
  63. Bao XH, Wong V, Wang Q, Low LC. Prevalence of peripheral neuropathy with insulin-dependent diabetes mellitus. Pediatr Neurol 1999; 20:204.
  64. Solders G, Thalme B, Aguirre-Aquino M, et al. Nerve conduction and autonomic nerve function in diabetic children. A 10-year follow-up study. Acta Paediatr 1997; 86:361.
  65. Abad F, Díaz-Gómez NM, Rodríguez I, et al. Subclinical pain and thermal sensory dysfunction in children and adolescents with Type 1 diabetes mellitus. Diabet Med 2002; 19:827.
  66. Jaiswal M, Lauer A, Martin CL, et al. Peripheral neuropathy in adolescents and young adults with type 1 and type 2 diabetes from the SEARCH for Diabetes in Youth follow-up cohort: a pilot study. Diabetes Care 2013; 36:3903.
  67. Barkai L, Kempler P, Vámosi I, et al. Peripheral sensory nerve dysfunction in children and adolescents with type 1 diabetes mellitus. Diabet Med 1998; 15:228.
  68. Hyllienmark L, Brismar T, Ludvigsson J. Subclinical nerve dysfunction in children and adolescents with IDDM. Diabetologia 1995; 38:685.
  69. Karavanaki K, Baum JD. Prevalence of microvascular and neurologic abnormalities in a population of diabetic children. J Pediatr Endocrinol Metab 1999; 12:411.
  70. Verrotti A, Chiarelli F, Blasetti A, Morgese G. Autonomic neuropathy in diabetic children. J Paediatr Child Health 1995; 31:545.
  71. Olsen BS, Sjølie A, Hougaard P, et al. A 6-year nationwide cohort study of glycaemic control in young people with type 1 diabetes. Risk markers for the development of retinopathy, nephropathy and neuropathy. Danish Study Group of Diabetes in Childhood. J Diabetes Complications 2000; 14:295.
  72. Soedamah-Muthu SS, Fuller JH, Mulnier HE, et al. High risk of cardiovascular disease in patients with type 1 diabetes in the U.K.: a cohort study using the general practice research database. Diabetes Care 2006; 29:798.
  73. Gøtzsche O, Darwish A, Gøtzsche L, et al. Incipient cardiomyopathy in young insulin-dependent diabetic patients: a seven-year prospective Doppler echocardiographic study. Diabet Med 1996; 13:834.
  74. Maahs DM, Maniatis AK, Nadeau K, et al. Total cholesterol and high-density lipoprotein levels in pediatric subjects with type 1 diabetes mellitus. J Pediatr 2005; 147:544.
  75. Maahs DM, Wadwa RP, McFann K, et al. Longitudinal lipid screening and use of lipid-lowering medications in pediatric type 1 diabetes. J Pediatr 2007; 150:146.
  76. Maahs DM, Dabelea D, D'Agostino RB Jr, et al. Glucose control predicts 2-year change in lipid profile in youth with type 1 diabetes. J Pediatr 2013; 162:101.
  77. Parikh A, Sochett EB, McCrindle BW, et al. Carotid artery distensibility and cardiac function in adolescents with type 1 diabetes. J Pediatr 2000; 137:465.
  78. Järvisalo MJ, Putto-Laurila A, Jartti L, et al. Carotid artery intima-media thickness in children with type 1 diabetes. Diabetes 2002; 51:493.
  79. Harrington J, Peña AS, Gent R, et al. Aortic intima media thickness is an early marker of atherosclerosis in children with type 1 diabetes mellitus. J Pediatr 2010; 156:237.
  80. American Diabetes Association. Management of dyslipidemia in children and adolescents with diabetes. Diabetes Care 2003; 26:2194.
  81. Petersen EE, Mitchell AA, Carey JC, et al. Maternal exposure to statins and risk for birth defects: a case-series approach. Am J Med Genet A 2008; 146A:2701.
  82. Vaisman N, Weintrob N, Blumental A, et al. Gastric emptying in patients with type I diabetes mellitus. Ann N Y Acad Sci 1999; 873:506.
  83. Cucchiara S, Franzese A, Salvia G, et al. Gastric emptying delay and gastric electrical derangement in IDDM. Diabetes Care 1998; 21:438.
  84. Chang J, Rayner CK, Jones KL, Horowitz M. Diabetic gastroparesis and its impact on glycemia. Endocrinol Metab Clin North Am 2010; 39:745.
  85. Samsom M, Vermeijden JR, Smout AJ, et al. Prevalence of delayed gastric emptying in diabetic patients and relationship to dyspeptic symptoms: a prospective study in unselected diabetic patients. Diabetes Care 2003; 26:3116.
  86. Horowitz M, O'Donovan D, Jones KL, et al. Gastric emptying in diabetes: clinical significance and treatment. Diabet Med 2002; 19:177.
  87. Bharucha AE, Camilleri M, Forstrom LA, Zinsmeister AR. Relationship between clinical features and gastric emptying disturbances in diabetes mellitus. Clin Endocrinol (Oxf) 2009; 70:415.
  88. Verrotti A, Chiarelli F, Amerio P, Morgese G. Necrobiosis lipoidica diabeticorum in children and adolescents: a clue for underlying renal and retinal disease. Pediatr Dermatol 1995; 12:220.
  89. Vuković J, Dumić M, Radica A, et al. Risk factors for expression and progression of limited joint mobility in insulin-dependent childhood diabetes. Acta Diabetol 1996; 33:15.
  90. Silverstein JH, Gordon G, Pollock BH, Rosenbloom AL. Long-term glycemic control influences the onset of limited joint mobility in type 1 diabetes. J Pediatr 1998; 132:944.
  91. Infante JR, Rosenbloom AL, Silverstein JH, et al. Changes in frequency and severity of limited joint mobility in children with type 1 diabetes mellitus between 1976-78 and 1998. J Pediatr 2001; 138:33.
  92. Schroeder B, Hertweck SP, Sanfilippo JS, Foster MB. Correlation between glycemic control and menstruation in diabetic adolescents. J Reprod Med 2000; 45:1.
  93. Kapellen TM, Galler A, Kiess W. Higher frequency of paronychia (nail bed infections) in pediatric and adolescent patients with type 1 diabetes mellitus than in non-diabetic peers. J Pediatr Endocrinol Metab 2003; 16:751.
  94. Verrotti A, Basciani F, Carle F, et al. Calcium metabolism in adolescents and young adults with type 1 diabetes mellitus without and with persistent microalbuminuria. J Endocrinol Invest 1999; 22:198.
  95. Yüksel H, Darcan S, Kabasakal C, et al. Effect of enalapril on proteinuria, phosphaturia, and calciuria in insulin-dependent diabetes. Pediatr Nephrol 1998; 12:648.
  96. Salvatoni A, Mancassola G, Biasoli R, et al. Bone mineral density in diabetic children and adolescents: a follow-up study. Bone 2004; 34:900.
  97. Chobot AP, Haffke A, Polanska J, et al. Bone status in adolescents with type 1 diabetes. Diabetologia 2010; 53:1754.
  98. Edge JA, Ford-Adams ME, Dunger DB. Causes of death in children with insulin dependent diabetes 1990-96. Arch Dis Child 1999; 81:318.
  99. Centers for Disease Control and Prevention (CDC). Racial disparities in diabetes mortality among persons aged 1-19 years--United States, 1979-2004. MMWR Morb Mortal Wkly Rep 2007; 56:1184.