Pediatric Diabetes 2007: 8: 163–170 All rights reserved # 2007 The Authors Journal compilation # 2007 Blackwell Munksgaard Pediatric Diabetes ISPAD Clinical Practice Consensus Guidelines 2006–2007 Microvascular and macrovascular complications Donaghue KC, Chiarelli F, Trotta D, Allgrove J, Dahl-Jorgensen K. Microvascular and macrovascular complications. Pediatric Diabetes 2007: 8: 163–170. Kim C Donaghue a , Francesco Chiarelli b , Daniela Trotta b , Jeremy Allgrove c and Knut Dahl-Jorgensen d a The Children’s Hospital at Westmead, University of Sydney, Sydney, Australia; b Department of Paediatrics, University of Chieti, Chieti, Italy; c Department of Paediatric Endocrinology and Diabetes, Royal London Hospital, London, UK d Department of Pediatrics, Ulleva ˚ l University Hospital and Faculty of Medicine, University of Oslo, Oslo, Norway Corresponding author: Kim C Donaghue MB BS PhD The Children’s Hospital at Westmead, Locked Bag 4001, Westmead, NSW 2145, Australia. 61 2 9845 3172 61 2 9845 3170 e-mail: kimd@chw.edu.au Acknowledgements: Esko Wiltshire, Gisela Dahlquist, Kenneth Lee Jones, Edna Roche, Amina Balafrej, and Riccardo Bonfanti. Editors of the ISPAD Clinical Practice Consensus Guidelines 2006–2007: Kim Donaghue, Ragnar Hanas, Georgeanna Klingensmith, and Peter Swift. The long-term vascular complications of diabetes in- clude retinopathy, nephropathy, neuropathy, and macro- vascular disease. The outcomes are the following: d Visual impairment and blindness due to diabetic retinopathy. d Renal failure and hypertension due to diabetic nephropathy. d Pain, paresthesiae, muscle weakness, and auto- nomic dysfunction due to diabetic neuropathy. d Cardiac disease, peripheral vascular disease, and stroke due to macrovascular disease. Clinically evident diabetes-related vascular compli- cations should be rare in childhood and adolescence. However, early functional and structural abnormal- ities may be present a few years after the onset of the disease. There has been a declining incidence of complica- tions reported in many areas with specialized clinics (1–3). This has occurred over a period of time during which there have been major changes in diabetes management, identification of putative risk factors, and the advent of regular screening for complications. There is no evidence that this is a worldwide occur- rence: in areas where health care is not optimal, a greater risk of complications will remain. Interventional studies of intensive glycemic control The Diabetes Control and Complications Trial (DCCT) was a multicenter, randomized controlled clinical trial involving 1441 patients with type 1 diabetes conducted in North America from 1983 to 1993 (4). At re- cruitment, 195 were pubertal adolescents (aged 13–17 yr): there were no children (5). After completion of the DCCT (a median of 7.4 yr in the adolescent group) and hence the end of randomization to the two treatment groups (intensive and conventional treat- ments), the Epidemiology of Diabetes Interventions and Complications (EDIC) study continued to follow patients (6). After 4 yr, there was no significant difference in hemoglobin A1c (HbA1c) between the former intensive and conventional treatment groups. The DCCT provided unequivocal evidence that intensive diabetes treatment and improved glycemic control conferred a significant risk reduction for microvascular complications compared with conven- tional treatment (5) (A). The EDIC study has shown that this positive effect continued after randomization, i.e., there was a memory effect of the improved glycemic control. In addition, it showed a positive effect of intensive therapy for reduction in macrovascular disease (7) (A). 163