Ann Pediatr Endocrinol Metab.  2023 Mar;28(1):20-25. 10.6065/apem.2244092.046.

The prevalence of diabetic peripheral neuropathy in youth with diabetes mellitus

Affiliations
  • 1Division of Endocrinology, Department of Pediatrics, Chulalongkorn University, and King Chulalongkorn Memorial Hospital, Thai Red Cross Societ y, Bangkok, Thailand
  • 2Department of Rehabilitation Medicine, Faculty of Medicine, Chulalongkorn University, and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand

Abstract

Purpose
Diabetic neuropathy (DN) is a serious complication in diabetes mellitus. We aimed to determine the prevalence of DN in pediatric-onset diabetes in a tertiary care center and to assess the sensitivity and specificity of monofilament testing and noninvasive screening to diagnose DN compared with the gold standard nerve conduction study (NCS).
Methods
Sixty-five Thai children and adolescents (39 females) diagnosed with diabetes before 15 years of age were included. All subjects were screened for DN by foot and neurological examinations, light touch sensation by 10 g Semmes-Weinstein monofilaments, and the Michigan Neuropathy Screening Instrument (MNSI). NCSs were used as the gold standard for diagnosis of DN.
Results
Fifty-eight patients had type 1 diabetes ( T1D), 5 patients had type 2 diabetes, and 2 patients had other types of diabetes. The mean age was 17.7±4.6 years (8–33 years). The prevalence of DN in this cohort was 12.3% by NCS. All subjects were asymptomatic. Mean diabetes duration did not differ between the groups (with DN 8.0±3.0 years vs. no DN 8.2±5.0 years). Notably, one patient with T1D developed DN within 3 years after diagnosis. Poor glycemic control was a significant risk factor for DN. Glycosylated hemoglobin was higher in the DN group (10.6%±2.3% vs. 8.5%±1.6%, P=0.008). The occurrence of diabetic nephropathy was associated with DN (prevalence rate ratio, 4.97; 95% confidence interval, 1.5–16.46). Foot and neurological examinations, monofilaments, and the MNSI failed to detect DN in all subjects with abnormal NCS.
Conclusion
The prevalence of DN in pediatric-onset diabetes is not uncommon but mainly is subclinical. Poor glycemic control is the main risk factor. Noninvasive screening tests for DN exhibited poor diagnostic sensitivity in the pediatric population.

Keyword

Diabetic neuropathy; Diabetes mellitus; Prevalence; Child; Risk factors

Reference

References

1. Akinci G, Savelieff MG, Gallagher G, Callaghan BC, Feldman EL. Diabetic neuropathy in children and youth: new and emerging risk factors. Pediatr Diabetes. 2021; 22:132–47.
2. Jaiswal M, Divers J, Dabelea D, Isom S, Bell RA, Martin CL, et al. Prevalence of and risk factors for diabetic peripheral neuropathy in youth with type 1 and type 2 diabetes: SEARCH for diabetes in youth study. Diabetes Care. 2017; 40:1226–32.
3. Hajas G, Kissova V, Tirpakova A. A 10-yr follow-up study for the detection of peripheral neuropathy in young patients with type 1 diabetes. Pediatr Diabetes. 2016; 17:632–41.
4. Lee SS, Han HS, Kim H. A 5-yr follow-up nerve conduction study for the detection of subclinical diabetic neuropathy in children with newly diagnosed insulin-dependent diabetes mellitus. Pediatr Diabetes. 2010; 11:521–8.
5. dos Santos LH, Bruck I, Antoniuk SA, Sandrini R. Evaluation of sensorimotor polyneuropathy in children and adolescents with type I diabetes: associations with microalbuminuria and retinopathy. Pediatr Diabetes. 2002; 3:101–8.
6. Eppens MC, Craig ME, Cusumano J, Hing S, Chan AK, Howard NJ, et al. Prevalence of diabetes complications in adolescents with type 2 compared with type 1 diabetes. Diabetes Care. 2006; 29:1300–6.
7. Jaiswal M, Lauer A, Martin CL, Bell RA, Divers J, Dabelea D, et al. Peripheral neuropathy in adolescents and young adults with type 1 and type 2 diabetes from the SEARCH for diabetes in youth follow-up cohort: a pilot study. Diabetes Care. 2013; 36:3903–8.
8. American Diabetes Association. 13. Children and adolescents: standards of medical care in diabetes-2021. Diabetes Care. 2021; 44(Suppl 1):S180–99.
9. Donaghue KC, Marcovecchio ML. ISPAD clinical practice consensus guidelines 2018: microvascular and macrovascular complications in children and adolescents. Pediatr Diabetes. 2018; 19:262–74.
10. Hirschfeld G, von Glischinski M, Blankenburg M, Zernikow B. Screening for peripheral neuropathies in children with diabetes: a systematic review. Pediatrics. 2014; 133:e1324–30.
11. Feldman EL, Stevens MJ, Thomas PK, Brown MB, Canal N, Greene DA. A practical two-step quantitative clinical and electrophysiological assessment for the diagnosis and staging of diabetic neuropathy. Diabetes C are. 1994; 17:1281–9.
12. Damri T, Chatchawan U. Validity and reliability of the Michigan Neuropathy Screening Instrument (MNSI) on the diabetic type II patients (Thai version). J Med Tech Phy Ther. 2015; 27:307–19.
13. Herman WH, Pop-Busui R, Braffett BH, Martin CL, Cleary PA, Albers JW, et al. Use of the Michigan Neuropathy Screening Instrument as a measure of distal symmetrical peripheral neuropathy in type 1 diabetes: results from the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications. Diabet Med. 2012; 29:937–44.
14. Boulton AJ, Armstrong DG, Albert SF, Frykberg RG, Hellman R, Kirkman MS, et al. Comprehensive foot examination and risk assessment: a report of the task force of the foot care interest group of the American Diabetes Association, with endorsement by the American Association of Clinical Endocrinologists. Diabetes Care. 2008; 31:1679–85.
15. Permsirivanich W, Piravej K. The comparison of nerve conduction studies in normal subjects by using MEDELEC and NIHON KOHDEN. J Thai Rehabil. 2003; 13:71–6.
16. Tesfaye S, Boulton AJM, Dyck PJ, Freeman R, Horowitz M, Kempler P, et al. Diabetic neuropathies: Update on definitions, diagnostic criteria, estimation of severity, and treatments. Diabetes Care. 2010; 33:2285–93.
17. Kang PB. Pediatric nerve conduction studies and EMG. In : Blum AS, Rutkove SB, editors. The clinical neurophysiology primer. New Jersey: Humana Press;2007. p. 369–89.
18. Miller RG, Kuntz NL. Nerve conduction studies in infants and children. J Child Neurol. 1986; 1:19–26.
19. Solders G, Thalme B, Aguirre-Aquino M, Brandt L, Berg U, Persson A. Nerve conduction and autonomic nerve function in diabetic children. A 10-year follow-up study. Acta Paediatr. 1997; 86:361–6.
20. Ang L, Jaiswal M, Martin C, Pop-Busui R. Glucose control and diabetic neuropathy: lessons from recent large clinical trials. Curr Diab Rep. 2014; 14:528.
21. DCCT Research Group. Effect of intensive diabetes treatment on nerve conduction in the diabetes control and complications trial. Ann Neurol. 1995; 38:869–80.
22. Nathan DM, Genuth S, Lachin J, Cleary P, Crofford O, Davis M, et al. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993; 329:977–86.
23. Trotta D, Verrotti A, Salladini C, Chiarelli F. Diabetic neuropathy in children and adolescents. Pediatr Diabetes. 2004; 5:44–57.
24. Ang L, Cowdin N, Mizokami-Stout K, Pop-Busui R. Update on the management of diabetic neuropathy. Diabetes Spectr. 2018; 31:224–33.
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