- •91% of children with TID may have electrophysiological abnormalities.
- •18% of children with T1D develop subclinical neuropathy.
- •Most common pattern of neuropathy in children is pure motor type.
- •Body mass index is an important predictor of neuropathy in children.
- •Nerve conduction should be performed to look for nerve dysfunction and progression.
To detect the prevalence of diabetic polyneuropathy (DPN) in children with type 1 diabetes (T1D) and to identify associated the risk factors.
This cross-sectional study evaluated children aged between 2 and 16y with T1D for ≥2 y. Detailed neurological examination, neuropathy symptom score, and nerve conduction studies were done in all children to assess nerve dysfunction. Disease-related factors were evaluated for the prediction of neuropathy.
Sixty-six children (67% boys) were enrolled. The mean age at the time of diagnosis of T1D was 7.1 ± 2.6 years. The mean duration of diabetes was 4 ± 1.8 years. None of the patients had neuropathy on clinical examination or on the neuropathy symptom score. The prevalence of subclinical DPN was 18.2% (n = 12/66). The type of neuropathy was pure motor (n = 11, 91.6%) and mixed sensorimotor (n = 1, 8.3%). The common peroneal nerve was most commonly affected (n = 6, 50%), followed by the tibial (n = 4, 33.3%) nerve. The most common patterns of nerve involvement were mixed axonal and demyelination (n = 7, 58.3%), followed by axonal (n = 3, 25%) and demyelinating type (n = 2, 16.6%). Children with subclinical DPN had a significant reduction in velocity of tibial, common peroneal, median motor, and ulnar motor nerves; delayed latency in common peroneal, median motor, ulnar motor, and median sensory nerves compared to those without DPN (p value <0.05). A higher body mass index predicted the development of subclinical DPN (p value <0.05).
Nearly one-fifth of children with T1D have subclinical neuropathy as early as two years of the disease. A higher body mass index is significantly associated with DPN. Electrophysiological studies should be performed regularly to screen for nerve dysfunction and its progression.
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- Care of children and adolescents with type 1 diabetes: a statement of the American Diabetes Association.Diabetes Care. 2005; 28: 186-212https://doi.org/10.2337/diacare.28.1.186
- High prevalence and incidence of diabetic peripheral neuropathy in children and adolescents with type 1 diabetes mellitus: results from a five-year prospective cohort study.Pediatr. Neurol. 2018; 80: 51-60https://doi.org/10.1016/j.pediatrneurol.2017.11.017
- Prevalence and risk factors for diabetic peripheral neuropathy in type 2 diabetic patients from 14 countries: estimates of the INTERPRET-DD study.Front. Public Health. 2020; 8534372https://doi.org/10.3389/fpubh.2020.534372
- Diabetic polyneuropathies: update on research definition, diagnostic criteria and estimation of severity.Diabetes Metab. Res. Rev. 2011; 27: 620-628https://doi.org/10.1002/dmrr.1226
- Diabetic neuropathy: a position statement by the American Diabetes Association.Diabetes Care. 2017; 40: 136-154https://doi.org/10.2337/dc16-2042
- Prevalence and its associated determinants of diabetic peripheral neuropathy (DPN) in individuals having Type-2 diabetes mellitus in Rural South India.Indian J. Community Med. 2019; 44: 88-91https://doi.org/10.4103/ijcm.IJCM_207_18
- Early electrophysiological abnormalities and clinical neuropathy: a prospective study in patients with type 1 diabetes.Diabetes Care. 2013; 36: 3187-3194https://doi.org/10.2337/dc12-2226
- Prevalence of cardiovascular autonomic neuropathy in a cohort of patients with newly diagnosed type 2 diabetes: the verona newly diagnosed type 2 diabetes study (VNDS).Diabetes Care. 2015; 38: 1487-1493https://doi.org/10.2337/dc15-0081
- Introduction.Aids to the Examination of the Peripheral Nervous System. 5th ed. Saunders Elsevier, London2010: 1-2
- Neuropathy symptom profile in health, motor neuron disease, diabetic neuropathy, and amyloidosis.Neurology. 1986; 36: 1300-1308https://doi.org/10.1212/wnl.36.10.1300
- Overview of the Neuropathies.Butterworth Heinemann Elsevier, Philadelphia PA2003: 339-359
- Overview of Pediatric Peripheral Neuropathies.2nd ed. Academic Press, USA2015: 274-288
- Basic Nerve Conduction Studies.2nd ed. Butterworth Heinemann Elsevier, Philadelphia PA2005: 25-45
- Detection, characterization, and staging of polyneuropathy: assessed in diabetics.Muscle Nerve. 1988; 11: 21-32https://doi.org/10.1002/mus.880110106
- Incidence of type 1 diabetes mellitus and associated complications among children and young adults: results from Karnataka Diabetes Registry 1995-2008.J. Indian Med. Assoc. 2008; 106: 708-711
- Electrophysiological characterization of neuropathy complicating type 1 diabetes mellitus.J. Diabetes Res. 2019; 20192435261https://doi.org/10.1155/2019/2435261
- Electrophysiologic pattern and prevalence of subclinical peripheral neuropathy in children and adolescents with type I diabetes mellitus in Iran.Saudi Med. J. 2016; 37: 299-303https://doi.org/10.15537/smj.2016.3.13625
- Vascular complications in young Asian Indian patients with type 1 diabetes mellitus.Diabetes Res. Clin. Pract. 2000; 48: 51-56https://doi.org/10.1016/s0168-8227(99)00134-5
- Clinical profile and incidence of microvascular complications of childhood and adolescent onset type 1 and type 2 diabetes seen at a tertiary diabetes center in India.Pediatr. Diabetes. 2021; 22: 67-74https://doi.org/10.1111/pedi.13033
- Clinical profile and complications of childhood- and adolescent-onset type 2 diabetes seen at a diabetes center in south India.Diabetes Technol. Ther. 2012; 14: 497-504https://doi.org/10.1089/dia.2011.0283
- Validity of the neurological examination in diagnosing diabetic peripheral neuropathy.Pediatr. Neurol. 2013; 49: 171-177https://doi.org/10.1016/j.pediatrneurol.2013.03.014
- High prevalence of diabetic polyneuropathy in a group of Brazilian children with type 1 diabetes mellitus.J. Pediatr. Endocrinol. Metab. 2005; 18: 1087-1094https://doi.org/10.1515/jpem.2005.18.11.1087
- 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: 521-528https://doi.org/10.1111/j.1399-5448.2009.00636.x
- Glycemic control and peripheral nerve conduction in children and young adults after 5-6 mo of IDDM. Wisconsin Diabetes Registry.Diabetes Care. 1992; 15: 502-507https://doi.org/10.2337/diacare.15.4.502
- Nerve conduction in children suffering insulin dependent diabetes mellitus.Indian J. Pediatr. 2003; 70: 945-951https://doi.org/10.1007/BF02723816
- Obesity and hyperlipidemia are risk factors for early diabetic neuropathy.J. Diabetes Complications. 2013; 27: 436-442https://doi.org/10.1016/j.jdiacomp.2013.04.003
- The relationship between glycemic variability and diabetic peripheral neuropathy in type 2 diabetes with well-controlled HbA1c.Diabetol. Metab. Syndr. 2014; 6: 139https://doi.org/10.1186/1758-5996-6-139
- Vascular risk factors and diabetic neuropathy.N. Engl. J. Med. 2005; 352: 341-350https://doi.org/10.1056/NEJMoa032782
- Higher body mass index predicts cardiac autonomic dysfunction: a longitudinal study in adolescent type 1 diabetes.Pediatr. Diabetes. 2018; 19: 794-800https://doi.org/10.1111/pedi.12642
- Prevalence and correlates of diabetic peripheral neuropathy in a Saudi Arabic population: a cross-sectional study.PLoS One. 2014; 9e106935https://doi.org/10.1371/journal.pone.0106935
- Diabetic neuropathy in children and adolescents with type 1 diabetes mellitus: diagnosis, pathogenesis, and associated genetic markers.Diabetes Metab. Res. Rev. 2019; 35: e3178https://doi.org/10.1002/dmrr.3178
- Association between glycemic variability and peripheral nerve dysfunction in type 1 diabetes.Muscle Nerve. 2016; 54: 967-969https://doi.org/10.1002/mus.25274
- Correlation of Michigan neuropathy screening instrument, United Kingdom screening test and electrodiagnosis for early detection of diabetic peripheral neuropathy.J. Diabetes Metab. Disord. 2015; 15: 8https://doi.org/10.1186/s40200-016-0229-7
Published online: January 05, 2022
Accepted: January 1, 2022
Received in revised form: December 20, 2021
Received: August 24, 2021
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