In the Swedish Study, http://care.diabetesjournals.org/cgi/content/abstract/30/10/2523, although the researchers state: HTML: that onset of diabetes before the age of 10 years, and thus prepubertal, significantly influenced the time to development of ESRD due to diabetic nephropathy. They also state: HTML: [B]This suggests, not that the early ages of onset are protective but rather that ?the clock does not run as fast? for the years before pubertal onset.[/B] Other studies have indicated that the prepubertal years with diabetes involve a reduced risk or a longer time to development of diabetic nephropathy and other microvascular complications, e.g., retinopathy (6,9,11,36 ?38). This same article clarifies that it isn?t that prepubertal damage isn?t occurring, but rather that damage occurs faster during puberty: HTML: The mechanism behind this effect of age at onset is not clear, but it has been speculated that puberty, characterized by both rapid growth, hormonal changes, and worsening in glycemic control, may accelerate the processes leading to chronic diabetes complications such as ESRD. Hyperglycemia is crucial and promotes early glomerular hyperfiltration and, in addition, stimulates pathways that may influence the development of diabetic nephropathy (39,40). A role of growth hormone has been indicated (41); however, the postpubertal susceptibility to diabetic nephropathy seems to be persistent during adulthood (9). Another recent article in Diabetes Care, http://care.diabetesjournals.org/cgi/content/abstract/30/10/2523, states: HTML: Increased A1C as a marker of chronic hyperglycemia is the most established and unquestioned risk factor for diabetic kidney disease in adult- and pediatric onset type 1 diabetes (11,13,14,17). The DCCT and the follow-up Epidemiology of Diabetes Interventions and Complications study clearly demonstrate that previous intensive treatment of diabetes with near-normal glycemia has an extended benefit in delaying the development and progression of diabetic nephropathy (9, 10). By Kaplan-Meier analysis, we found that a cumulative A1C of 7.5% significantly raised the probability of micro- and macroalbuminuria. This effect became evident after diabetes duration of 10 years for microalbuminuria and 20 years for macroalbuminuria. Therefore, efforts to normalize metabolic control should be started right from diabetes onset, although consequences on renal function might not be seen before adult age. The article goes on to describe the risk in young children: HTML: Several studies have indicated that prepubertal duration of diabetes delays the onset of diabetic nephropathy. In our study, microalbuminuria was delayed by very early onset of diabetes and confirmed these previous prospective studies (14,31,32). [B]We do not suggest that poor metabolic control in prepubertal children does not add to the risk of microvascular complications, but there is evidence that it does so at a lower rate[/B] (33).