Long-term outlook for children with type-1 diabetes, microalbuminuria and renal disease

As childhood-onset type-1 diabetes increases in incidence worldwide, its onset is shifting towards younger ages. Thus, the relative proportion of adolescents and young adults with a very long duration of type-1 diabetes may gradually increase. Early-onset diabetes may increase the lifetime risk for diabetic vascular complications, although there are other factors – such as long-term glycaemic control, puberty, and familial and genetic factors – which contribute to the overall risk. The focus of this minireview is the natural history of microalbuminuria in children and adolescents with type-1 diabetes. Late complications in type-1 diabetes are almost always subclinical during childhood and adolescence, and advanced vascular complications are rarely seen. Microalbuminuria may appear as the first sign of microvascular complications, and although it may be intermittent or transient in most young patients, screening is important in clinical diabetes care since microalbuminuria is also a strong risk marker for early cardiovascular morbidity.