© 2002 Archives of Disease in Childhood
LEADING ARTICLE
Screening
Markers of microvascular complications in insulin dependent diabetes
Department of Paediatrics, Addenbrooke's Hospital, Cambridge CB2 2QQ, UK
Correspondence to:
Correspondence to:
Prof. D B Dunger, Department of Paediatrics, Addenbrooke's Hospital, Cambridge CB2 2QQ, UK;
david.dunger@paediatrics.ox.ac.uk
Annual screening for early markers of microvascular disease during puberty should be encouraged
Keywords: diabetes; screening; insulin; microvascular disease
Abbreviations: ACE, acetylcholinesterase; ACR, albumin-creatinine ratio; BP, blood pressure; DCCT, Diabetes Control and Complications Trial; MA, microalbuminuria; ORPS, Oxford Regional Prospective Study; TIDM, type 1 diabetes mellitus
| The first 150 words of the full text of this article appear below. |
Screening for early markers of microvascular disease is now generally recommended from around the age of 10 years in children with type 1 diabetes mellitus (TIDM). Annual assessment should include direct fundal examination or fundus photography, monitoring of arterial blood pressure (BP), and measurement of urinary albumin excretion. The basis of all screening programmes is that those most at risk can be correctly identified and that there should be appropriate and effective interventions. The value of retinal screening is beyond doubt as the detection of early preproliferative or proliferative retinopathy may lead to successful intervention with laser therapy, but such events are rare before the age of 18 years. The evidence supporting screening for other markers of microvascular disease, such as microalbuminuria (MA) and hypertension is more contentious and this is the subject of the current review. Symptomatic autonomic or sensory nephropathy is relatively rare in children and adolescents
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