MMPAD Milan Meeting Report

15 European Roadshow - Milan, 29 June 2018 MEETING REPORT CHRONIC COMPLICATIONS Presented by Dr. Cosimo Giannini – University of Chieti The chronic complications of T1D are vascular in nature and include diabetic neuropathy, retinopathy and nephropathy. There is also an increased risk of cardiovascular mortality of 2-4 times and stroke. The presence of one or more chronic complications of T1D in young patients results in nearly 60% deaths. The pathogenesis of vascular complications is complex and still not fully understood. Certainly the presence of micro- and macrovascular complications adversely affects the prognosis of T1D in children and adolescents. Diabetic nephropathy (DN) Its cumulative incidence ranges from 15 to 40% and is the main cause of end-stage renal failure, as well as a major cause of morbidity and mortality . 20 Reflection: Clinical manifestations of diabetic nephropathy Five stages of disease are recognise d 21 Fig. 3. Clinical stages of diabetic nephropathy AER: albumin excretion rate; ACR: albumin/creatinine ratio The earliest clinical manifestation of DN is microalbuminuria, the risk of which is related to HbA1c levels and duration of diabetes. Other risk factors of microalbuminuria during adolescence are female sex and puberty, hypertension, dyslipidaemia, smoking and GH/IGF-I axis imbalance in favour of GH. High glycemic variability represents an additional risk factor. An extract from Dr. Giannini‘s presentation is available here Stage 1 Hyperfiltration/hyperperfusion Stage 2 Silent Phase Morphological changes Stage 3 Stage 4 Stage 5 Terminal nephropathy Microalbuminuria - AER: 20-200 μg/min or 30-300 mg/24h - ACR: 2.5-25 mg/mmol Microalbuminuria/proteinuria - AER: >200 μg/min or >300 mg/24h - ACR: >25 mg/mmol