Abstract
AIM: To quantify the prevalence of microvascular complications of children and adolescents with type 1 and type 2 diabetes by performing a meta-analysis of observational studies. METHODS: A systematic search in PubMed, EMBASE, and Web of Science was performed from 2000 to August 2025. Studies that reported the prevalence of microvascular complications in children and adolescents with diabetes were included. Study characteristics and prevalence estimates were extracted from each study. Pooled prevalence rates for microvascular complications were calculated using a random-effects model with Freeman-Tukey double arcsine transformation to stabilize variance. RESULTS: A total of 57 studies were included, comprising 51,819 children and adolescents diagnosed with diabetes (type 1: n = 44,150 and type 2: n = 7,669), with a mean age of 14.5 and 15.2 years old, respectively. Pooled prevalence of complications in youth with type 1 vs. type 2 diabetes was 22.07% (95% CI: 16.86-27.75) vs. 11.04% (95% CI: 2.73-23.45) for peripheral neuropathy, 31.98% (95% CI: 11.13-57.44) vs. 15.37% (95% CI: 3.09-34.29) for autonomic neuropathy, 13.76% (95% CI: 6.43-23.24) vs. 2.97% (95% CI: 0.00-10.33) for retinopathy, and 13.70% (95% CI: 10.25-17.54) vs. 12.63% (95% CI: 7.99-18.07) for nephropathy, with high heterogeneity across studies and no significant differences between diabetes types. Meta-regression analyses showed no significant associations between complication prevalence and HbA1c, diabetes duration, lipid levels, cohort year, or age. CONCLUSIONS/INTERPRETATION: Microvascular complications affect at least one in 10 youths with diabetes before age 20, with similar prevalence in type 1 and type 2 diabetes. Given the high rates and early onset, routine screening and early intervention are essential for all young people with diabetes to prevent or limit progression of vascular damage, regardless of diabetes type, glycemic stability, or disease duration.