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March 07-08, 2019 | London, UK
Journal of Diabetology | Volume 3
Annual Summit on
Diabetes, Obesity & Heart
Diabetes, Endocrinology and Metabolic Syndrome
International Conference on
Joint Event
&
Vascular complications in type 2 diabetes mellitus in children and adolescents
Hesham Fouad
International Clinic, Kuwait
T
ype 2 diabetes in in children and adolescents is different, not
only from type 1 diabetes, but also from type 2 diabetes in
adults, as it has a more rapidly progressive reduction in β-cell
functionandaccelerateddevelopmentofdiabetescomplications.
Accordingly, secondary comorbidities like hypertension,
nephropathy, the leading cause of end-stage renal disease,
hyperlipidaemia, stroke, 2- to 4- fold increase in cardiovascular
mortality, cardiovascular disease, diabetic neuropathy, a leading
cause of non-traumatic lower extremity amputations and
retinopathy, the leading causeof blindness inworking age adults,
are anticipated and their development and progressionmight be
especially rapid because of the early onset of type 2 diabetes in
such patients. This will raise the possibility of a serious public-
health challenge in the next few decades and we must begin to
understand the extent of this upcoming challenge. Risk factors
for development of diabetic angiopathy are disease duration,
poor metabolic control, hypertension, hyperlipidemia, smoking,
puberty and genetic factors. Furthermore, the mechanism by
which poor glycemic control predisposes to vascular disease is
incompletely understood. The pathogenesis of diabetic vascular
complications include accumulation of advanced glycosylation
end products in plasma, induced by hyperglycemia, that
contribute to microvascular disease, accumulation of cellular
sorbitol, which interferes with cellular metabolism because of a
rise in cell osmolality and a decrease in intracellular myoinositol,
end-organ response with activation of cytokines, profibrotic
elements, vascular growth factors, inflammation, and protein
kinase C. Specific end organ responses include mesangial
matrix expansion and glomerular hypertension in the kidney,
and impairment of retinal blood flow and microthrombus
formation in the eye. The role of these factors in advancement
of diabetic vascular problems and the feasible therapeutic goals
for these illnesses has been explained within this presentation.
Improved glycemic control and control of hypertension delay the
progressionofmicrovascular disease. Therefore, all patientswith
T2DM should be screened for microvascular complications to
identify those with microvascular disease and initiate treatment
when complications are discovered to delay or prevent further
progression of disease. The role of growth factors in the
pathogenesis of diabetic angiopathy and their relation to later
development of microalbuminuria in a pathway to vascular
complications will be illustrated. This presentation will review
the contribution of dysfunction of the vascular endothelium to
the pathogenesis of diabetic micro- and macroangiopathy in
children and adolescents with type 2 diabetes. The biochemical
basis for the effects of hyperglycemia on the pathogenesis
of diabetic angiopathy will be discussed. Recently, it is found
that the metabolic milieu that are the key factors leading to
vascular complications in T2DM. In this lecture, an attempt has
been made to comprehensively compile updated information
available in context of endothelial and platelet dysfunction in
T2DM in children and adolescents. The data presented in this
presentationwere obtained frompublished literature presented
at scientific meetings, clinical trials and review articles using the
search terms Hyperglycemia, Insulin resistance, Inflammation,
Oxidative stress, vascular complications, ‘type 2 diabetes
mellitus’, ‘children’, and ‘adolescents’ in a MEDLINE search from
1995-2018. Additionally, the bibliographies in the identified
articles were reviewed.
e:
heshamfouad547@hotmail.com