High Prevalence and Incidence of Diabetic Peripheral Neuropathy in Children and Adolescents with Type 1 Diabetes Mellitus: Results From a 5-Year Prospective Cohort Study

Publication date: Available online 13 December 2017
Source:Pediatric Neurology
Author(s): Isabella Walter-Höliner, Daniela Seick Barbarini, Jürg Lütschg, Anya Blassnig-Ezeh, Ulrike Zanier, Christoph H. Saely, Burkhard Simma
Backgroundin this prospective cohort study we aimed at investigating the prevalence of diabetic peripheral neuropathy (DPN) at baseline and after 5 years of follow-up in children and adolescents with type 1 diabetes mellitus (T1DM), using both measurements of nerve conduction velocity (NCV) and clinical neurological examination.Methodsa total of 38 patients aged 12.6 ± 2.4years was included, with a diabetes duration of 5.6 ± 3.2 years, who were treated with insulin pump or intensive insulin therapy. All patients underwent a detailed physical, neurological and electrophysiological examination as well as laboratory testing at their annual check-up.Resultsat baseline, the prevalence of DPN diagnosed with neurological examination was 13.2%, whereas NCV testing revealed DPN in 31.6%, highlighting a high prevalence of subclinical DPN. During follow-up, there was a strong increase in the prevalence of clinically diagnosed DPN, which reached 34.2% (p=0.039) after 5 years; the proportion of patients with subclinical DPN even reached 63.2% (p=0.002). The most significant changes in electrophysiological parameters were observed in the tibial sensor nerve (p=0.001).Conclusionswe conclude that the prevalence of DPN in children and adolescents with T1DM is high and that there is a rapid increase in the prevalence of DPN over 5-year follow-up. Importantly, our data show that a mere clinical evaluation is not sensitive enough to diagnose DPN in these patients. The gold standard of NCV measurements for the assessment of DPN should be applied more broadly.



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