MMPAD Milan Meeting Report

16 European Roadshow - Milan, 29 June 2018 MEETING REPORT Research into new biomarkers of renal cell damage is being carried out through proteomics and metabolomics. Urinary cytokines/chemokines have been identified as markers of renal hyperfiltration in adolescents with T1D . 22 Emerging perspectives include the identification of biomarkers of glomerular (including albumin, transferrin, ceruloplasmin) or tubular (including α1 and β2 g-microglobulin) damage, oxidative stress and renal inflammation (including TNF-α, VEGF, IL-6) . 23 Screening for DN should start in children aged 10 years or at the beginning of puberty and in cases of diabetes of 2-5 years duration through evaluation of albumin/creatinine ratio (ACR) or albumin excretion rate (AER; ISPAD guidelines 2014 and 2018). To control DN ACE inhibitors have been proposed to prevent the progression from microalbuminuria to proteinuria, although a recent trial demonstrated a non-statistically significant effect. Diabetic retinopathy Reflection: the four stages of diabetic retinopathy 1. Non-proliferative retinopathy with intraretinal microvascular abnormalities and bleeding 2. Pre-proliferative retinopathy with the addition of venous irregularities 3. Proliferative retinopathy with neoformation of vessels fed by retinal artery 4. Maculopathy with macular edema and hard exudates The prevalence of retinopathy tends to increase with duration of diabetes and age and is higher in females. Other major risk factors for diabetic retinopathy are hyperglycaemia, hypertension, hyperlipidaemia, pregnancy and kidney disease; and to a lesser extent obesity, smoking, alcohol, and physical inactivity. Retinopathy screening should also be carried out on children from the age of 10 years with diabetes for 2-5 years, using fundus imaging or mydriatic ophthalmoscopy. Retinopathy prevention uses the usual microvascular complication prevention strategies in T1D: optimising glycaemic control, correction of lifestyles, blood lipid control and, above all, arterial pressure control.