Chapter

Adolescence and emerging adulthood

David Levy

in Type 1 Diabetes

Published on behalf of Oxford University Press

ISBN: 9780199553211
Published online September 2011 | e-ISBN: 9780191740190 | DOI: http://dx.doi.org/10.1093/med/9780199553211.003.0007

Series: Oxford Diabetes Library

Adolescence and emerging adulthood

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• During puberty and adolescence there are profound changes in endocrinology, especially in the growth hormone axis, but their contribution to vascular complications is still not clear. • Microvascular complications occur from puberty onwards. The contribution of prepubertal duration to microvascular complications is less than that of pubertal duration, but is not negligible. • Advanced microvascular complications are probably less prevalent now than in the past, though there is little systematic evidence that glycaemic control has improved in this age group. • Hypertension, especially systolic, is frequent, and is probably related to multifactorial premature arterial stiffness. Subtle changes in lipid profile may contribute, but their impact is not known. Cigarette smoking is still common, probably underestimated, and clinical teams need to do more to improve cessation rates. • The evidence base for treatment of identified macrovascular risk factors is weak, and only a small proportion is currently treated pharmacologically. • Transition to adult care is difficult, should be managed actively, and must take into account the high prevalence of psychosocial morbidity in subgroups, especially young women with eating disorders.

Chapter.  6772 words.  Illustrated.

Subjects: Endocrinology and Diabetes

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