ESPE Abstracts

Objective: To determine the frequency, clinical spectrum, and risk factors for microvascular complications in children and adolescent with T1DM.

Methodology: Descriptive, observational study was conducted over 1 year (April 2023 till March 2024) at the Department of Pediatric Endocrinology and Diabetes, The Children's Hospital, Lahore, Pakistan. Total 127 patients, aged 1 to 18 years having minimum 3 years of T1DM in age group 1 to ≤ 10 years and 2 years in the age group ≥11 till 18 years were enrolled. We defined nephropathy as an early morning urine albumin-to-creatinine ratio (UACR), exceeding 300 mg/g on two different occasions, at least three months apart. Michigan Neuropathy scoring instrument (MNSI) was based to document Diabetic peripheral neuropathy (DPN) if >2 score on its clinical form. Fundoscopy and slit lamp examination were done by an experienced ophthalmologist to evaluate for diabetic retinopathy.

Results: Out of 127 patients, 54%(n = 68) were females and 46% (n = 59) were males. Mean age was 12.8±2.5 years. Mean HbA1c was higher in females (9.4±1.7) than male (9.3±1.9). Mean duration of diabetes was 6.1±2.8 years and 42.5%(n = 54) of the patients had a disease duration between 5 to 7 years. Diabetic Nephropathy (DN) was the most common microvascular complication (39.3%, n = 50). Mean age at the presentation with Diabetic nephropathy was 13.4±2.2 respectively. Most importantly,26%(n = 6/23) of the patients were ≤10 years of age. DN was followed by diabetic peripheral neuropathy (17.8%, n = 22), with mean age of 14.7 ± 2.5 years. Non-proliferative diabetic retinopathy (NPDR) was the most common retinal complication found in 14.5% (n = 19), having mean of 16 ± 2.2 years. Maculopathy was determined in only one patient. Various factors like gender, age, socioeconomic status, area of residence, education of caregiver, Tanner staging, BMI and HbA1C were analyzed. Poor glycemic control (p-value,0.004), advancing age≥11years (p-value,0.002), and duration of disease≥5 years (p-value,0.03) were found to be significantly associated with microvascular complications.

Conclusion: Microvascular complications have risen in children and adolescents, aged 11-18 years, with a worrying increase in diabetic nephropathy in our children ≤ 10 years of age. Based on this, we strongly suggest revising the screening guidelines for diabetic nephropathy, especially in resource-limited settings. This could potentially lead to earlier detection and better management of the condition. We emphasize nationwide standardized diabetes management to improve glycemic control and stress the importance of early screening, especially in resource limited settings.

Keywords: Microvascular, Type 1 diabetes, Children, adolescent.