1. Microvascular complications including diabetic kidney disease, retinopathy, and neuropathy are widely prevalent in youth with type 1 and type 2 diabetes; yet, these complications are frequently underdiagnosed and undertreated, thus placing these individuals at significantly higher risk for diabetes-related morbidity and mortality.

2. Diabetic kidney disease arises primarily from glomerular and tubular damage sustained from a combination of factors including hyperglycemia and glomerular hypertension with associated hyperfiltration; thus, first-line treatments center on the normalization of glycemia and the use of renin-angiotensin system blockers to reduce intraglomerular pressure.

3. Retinopathy is the most common microvascular complication in youth with diabetes and loss of glycemic control and concurrent diabetic kidney disease remain the most significant risk factors for the development of retinopathy in youth with diabetes.

4. Distal symmetric polyneuropathy is the most common neuropathy associated with a diagnosis of diabetes in youth and it can co-exist with cardiac autonomic neuropathy, a significant risk factor contributing to morbidity and mortality related to cardiovascular disease.

5. Future large, prospective pediatric outcome trials are needed to investigate the use of singular and combination pharmacological therapies for the treatment of microvascular complications in youth with type 1 and type 2 diabetes.