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Early microvascular complications in type 1 and type 2 diabetes: recent developments and updates

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Abstract

The prevalence of youth-onset diabetes is progressing rapidly worldwide, and poor glycemic control, in combination with prolonged diabetes duration and comorbidities including hypertension, has led to the early development of microvascular complications including diabetic kidney disease, retinopathy, and neuropathy. Pediatric populations with type 1 (T1D) and type 2 (T2D) diabetes are classically underdiagnosed with microvascular complications, and this leads to both undertreatment and insufficient attention to the mitigation of risk factors that could help attenuate further progression of complications and decrease the likelihood for long-term morbidity and mortality. This narrative review aims to present a comprehensive summary of the epidemiology, risk factors, symptoms, screening practices, and treatment options, including future opportunities for treatment advancement, for microvascular complications in youth with T1D and T2D. We seek to uniquely focus on the inherent challenges of managing pediatric populations with diabetes and discuss the similarities and differences between microvascular complications in T1D and T2D, while presenting a strong emphasis on the importance of early identification of at-risk youth. Further investigation of possible treatment mechanisms for microvascular complications in youth with T1D and T2D through dedicated pediatric outcome trials is necessary to target the brief window where early pathological vascular changes may be significantly attenuated.

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Funding

KLT receives salary and research support from the NIDDK (5T32DK007135-46), ISPAD-JDRF Research Fellowship, Center for Women’s Health Research at the University of Colorado, and the Department of Pediatrics, Section of Endocrinology at the University of Colorado School of Medicine. ALBS receives salary and research support from NIDDK (K01DK120562) and the Lifecourse Epidemiology of Adiposity and Diabetes Center at the University of Colorado, Departments of Epidemiology and Pediatrics. PB receives salary and research support from NIDDK (DK116720, DK114886), JDRF (2-SRA-2019-845-S-B, 3-SRA-2017-424-M-B), American Heart Association (20IPA35260142), Boettcher Foundation, Center for Women’s Health Research at University of Colorado, the Department of Pediatrics, Section of Endocrinology and Barbara Davis Center for Diabetes at the University of Colorado School of Medicine.

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  1. Department of Pediatrics, Section of Pediatric Endocrinology, Children’s Hospital Colorado and University of Colorado Anschutz Medical Campus, 13123 E. 16th Avenue, Box B265, Aurora, CO, 80045, USA

    Kalie L. Tommerdahl, Allison L. B. Shapiro & Petter Bjornstad

  2. Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, CO, USA

    Kalie L. Tommerdahl

  3. Center for Women’s Health Research, University of Colorado School of Medicine, Aurora, CO, USA

    Kalie L. Tommerdahl & Petter Bjornstad

  4. Department of Medicine, Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, CO, USA

    Kalie L. Tommerdahl & Petter Bjornstad

  5. Lifecourse Epidemiology of Adiposity and Diabetes Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA

    Allison L. B. Shapiro

  6. Division of Nephrology and Hypertension, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    Edward J. Nehus

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  1. Kalie L. Tommerdahl
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Correspondence to Petter Bjornstad.

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KLT, ALBS, and EJN have nothing to disclose. PB has acted as a consultant for AstraZeneca, Bayer, Bristol-Myers Squibb, Boehringer Ingelheim, Eli-Lilly, Sanofi, Novo Nordisk and Horizon Pharma. PB serves on the advisory boards for AstraZeneca, Bayer, Boehringer Ingelheim, Novo Nordisk and XORTX.

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1. b; 2. b; 3. d; 4. c; 5. a

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Tommerdahl, K.L., Shapiro, A.L.B., Nehus, E.J. et al. Early microvascular complications in type 1 and type 2 diabetes: recent developments and updates. Pediatr Nephrol 37, 79–93 (2022). https://doi.org/10.1007/s00467-021-05050-7

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