Detection by nailfold capillary microscopy of early morphologic capillary changes in children with insulin dependent diabetes mellitus

Nailfold capillary microscopy (NCM) is a non invasive method to investigate digital microcirculation. The NCM pattern of 70 children with diabetes (duration varying from less than one month to 18 years) and of 35 healthy children was studied. Several capillary loops anomalies were observed: haemorrhages, disorganisation, dystrophies, microaneurysms. The anomalies were more frequent in children with diabetes (61.4%) than in the controls (20%; p less than 0.001). Haemorrhages and nailbed disorganisation were seen in both groups. Dystrophies were found more frequently in the diabetic group (46%) than in the controls (17%; p less than 0.01). Microaneurysms were observed only in diabetic children (27%; p less than 0.001); they were present in 18.5% of the children with a diabetes duration of less than 2 years and their frequency did not increase with the duration of the disease. Sex ratio, age and HbA1c were not different between the diabetic children with or without microaneurysms. No relationship was found between retinal angiography and NCM detection of the microaneurysms. In conclusion, NCM is able to detect frequent anomalies of the digital microcirculation, especially microaneurysms, early in the course of diabetes in children. The follow up of this pediatric population will provide further information on the prognostic value of these lesions.