Abstract
Type 2 diabetes mellitus (T2DM) is an increasing problem in childhood; however type
1 diabetes mellitus (T1DM) remains by far the most common type of diabetes in this
age group. In this review we will focus on T1DM, because this will have the greatest
implication for patients diagnosed in childhood. During the atherosclerotic process,
several molecular, receptorial and cellular factors provide a continous mechanism
of vascular damage. In diabetic children this state seems to be enhanced and facilitated
so that accelerated atherosclerosis is associated with an increased risk of cardiovascular
events in respect to the non diabetic population. Hyperglycemia per se and associated with diabetes is an important risk factor for atherosclerosis. At
present a substantial part of children with diabetes do not reach satisfactory glycemic
control. Other risk factors for the development and progression of atherosclerosis
may be inherited or develop in the course of the disease: hypertension, dyslipidemia,
insulin resistance, obesity, cigarette smoking, physical inactivity, disturbance of
platelet function, coagulation and fibrinolysis. The development and progression of
atherosclerosis should be blocked at an early age, if possible. Primary prevention
to all risk factors for cardiovascular disease is important and intervention is indicated
if necessary. At the moment the best therapeutic strategy is to maintain metabolic
control at a physiologic level and perform screening and early intervention for vascular
complications.
Key words
Diabetes mellitus - hyperglycemia - atherosclerosis - TNF-α - macrophages - smooth
muscle cells - lipids - macroangiopathy - nitric oxide
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Correspondence
Francesco ChiarelliM.D., Ph.D.
Department of Pediatrics·University of Chieti
Via dei Vestini 5
66100 Chieti
Italy
Telefon: +39/0871/35 80 15
Fax: +39/0871/57 48 31
eMail: chiarelli@unich.it
