Adolescence is a vulnerable period for patients with diabetes. This regional survey demonstrated a marked decline in clinic attendance around the time of transition from paediatric to adult services. The reasons are complex, but mode of transfer may be an important factor.

SUMMARY Albuminuria was studied in 40 diabetic children before and after a standardised exercise test, and also in 21 normal children; the results are expressed as geometric mean (95% range) of urine albumin:urine creatinine ratio (mg/mg). There was no significant difference between the mean resting albumin:creatinine ratio in the two groups, or between these ratios before and after exercise in the normal children. In the diabetic children, however, the mean urine albumin:creatinine ratio after exercise was significantly higher than both the value before exercise and the postexercise value of the normal children, with 10 of 40 diabetic children showing a value after exercise greater than the 95% range of the geometric mean of the control group.The diabetic children were also studied by random urine albumin:creatinine ratios and split (erect:supine) 24 hour urine collection; none was abnormal. Several studies, mainly in adults, have shown that before the onset of overt proteinuria, many diabetics have a higher mean urinary albumin excretion rate than normal subjects, and that this early 'microalbuminuria' is at least partially correctable by strict metabolic control.4 Other studies have delineated low and high risk groups for the development of diabetic nephropathy on the basis of overnight albumin excretion rates before the onset of overt proteinuria.5Exercise increases urinary albumin excretion. During exercise it seems likely that the glomerulus becomes leaky when a higher filtration pressure operates. If the membrane is already abnormal or stressed in some way the increased leak will occur at a lower threshold and to a more noticeable degree. Thus it may be possible to identify a subgroup within the diabetic population at particular risk of developing diabetic nephropathy at the early stage of slightly raised albumin excretion using exercise as a probe to unmask latent glomerular damage.Previous studies have been mainly in adults and have involved the use of albumin clearance or excretion rates;69 these studies are difficult to perform in children because of the problems of collection of accurately timed and measured volumes of urine.The use of the urine albumin: urine creatinine ratio minimises the errors due to variations in the glomerular filtration rate and has been shown to be a useful measure of overall glomerular permeability,'0 although it does not take account of nephron hyperfiltration or tubular reabsorption. The albumin:creatinine ratio on random specimens has been shown to correlate well with the albumin excretion ratel' 11 and has the advantage of not requiring timed and measured urine collection.In this pilot study the urine volumes and collection times for diabetic children were noted and blood samples were taken before the start of exercise to allow comparison between the albumin: 305 on 10 May 2018 by guest. Protected by copyright.

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