I have read some studies recently that show cardiovascular changes early on in children with diabetes, irrespective of their A1c scores. Do you know much about this? My son has had diabetes since he was one year old. He is now seven and there is a family history of heart disease. We try to control his diabetes well, but I am concerned that even with the best care he will have early heart problems. Any suggestions or comfort you can provide me?

All the complications associated with diabetes clearly are related to levels of glucose over many years, as well as hereditary factors that act as susceptibility factors — changing the potential. So, if there are a lot of heart attacks from hyperlipidemia, then this is an added risk factor for your child as well. It is the same for hypertension, strokes, thyroid disorders, kidney problems etc. A detailed talk with your diabetologist would give you some more information that is specific for your child.

Important from my perspective to (1) know family history such as this, (2) reduce associated risk factors, and (3) have appropriate monitoring as indicated. For example, make sure thyroid functions are checked at least annually if other family members have thyroid disorders; same for lipids, blood pressure, kidney function etc. With diabetes as an added risk factor under such circumstances, intervention that is more aggressive may be in order although most such problems do not require medication, unless there is a major abnormality. Subtle abnormalities after adolescence may suggest earlier intervention than would otherwise be the case since there would be multiple risk factors (i.e. diabetes plus mild hypertension or moderate hyperlipidemia). So, we do not believe that all such problems are inevitable and, with appropriate glucose control, A1c control, monitoring of these other risk factors and earlier interventions (i.e. ACE inhibitors, statins, aspirin, antioxidants, not smoking, avoiding obesity), these types of risk factors can be overcome.

SB