Peripheral Neuropathy in Children and Adolescents with Insulin-dependent Diabetes Mellitus
Iranian Journal of Child Neurology,
Vol. 12 No. 2 (2018),
14 March 2018
,
Page 83-90
https://doi.org/10.22037/ijcn.v12i2.13749
Abstract
Introduction: Type 1 diabetes mellitus(T1DM) is a chronic immune-mediated disease. Diabetic peripheral neuropathy (DPN) is an important micro vascular complication of T1DM. One of the most important risk factors for the development of DPN is poor glycemic control. The aim of this study was to evaluate the prevalence of DPN among T1DM patients and to determine the association between DPN and glycated hemoglobin(HbA1c) level.
Methods: The subjects were recruited prospectively upon initial evaluation at a tertiary hospital. Patients with T1DM were selected based on the inclusion criteria (i.e., age of 6≤years and absence of other co-morbidities). DPN was assessed through electro diagnostic studies and neurological examinations, while diabetes control was evaluated by measuring the HbA1c level.
Results: In total, 50 patients with T1DM were enrolled in this study. The mean diabetes duration of patients was 8.38±3.79 years (mean age16.68±6.68 years). The mean HbA1c level was 8.6±2.1% in patients without DPN and 10.5±3 in those with DPN (P=0.016). Overall, 24% of the subjects were presented with DPN according to nerve conduction velocity(NCV) findings. A positive correlation was found between NCV and clinical symptoms with signs (P<0.001, r=0.45 and P<0.001, r=0.644, respectively). Sensitivity and specificity of neurological examination for DPN diagnosis were 91.7% and 63.2%, respectively. Our findings revealed that, poor diabetes control is associated with DPN. Also, HbA1c level was used as an index for glycemic control over the past six months.
Conclusion: It seems that rigid blood glucose control and periodic neurological examinations were the best strategies to prevent DPN.
Introduction: Type 1 diabetes mellitus(T1DM) is a chronic immune-mediated disease. Diabetic peripheral neuropathy (DPN) is an important micro vascular complication of T1DM. One of the most important risk factors for the development of DPN is poor glycemic control. The aim of this study was to evaluate the prevalence of DPN among T1DM patients and to determine the association between DPN and glycated hemoglobin(HbA1c) level.
Methods: The subjects were recruited prospectively upon initial evaluation at a tertiary hospital. Patients with T1DM were selected based on the inclusion criteria (i.e., age of 6≤years and absence of other co-morbidities). DPN was assessed through electro diagnostic studies and neurological examinations, while diabetes control was evaluated by measuring the HbA1c level.
Results: In total, 50 patients with T1DM were enrolled in this study. The mean diabetes duration of patients was 8.38±3.79 years (mean age16.68±6.68 years). The mean HbA1c level was 8.6±2.1% in patients without DPN and 10.5±3 in those with DPN (P=0.016). Overall, 24% of the subjects were presented with DPN according to nerve conduction velocity(NCV) findings. A positive correlation was found between NCV and clinical symptoms with signs (P<0.001, r=0.45 and P<0.001, r=0.644, respectively). Sensitivity and specificity of neurological examination for DPN diagnosis were 91.7% and 63.2%, respectively. Our findings revealed that, poor diabetes control is associated with DPN. Also, HbA1c level was used as an index for glycemic control over the past six months.
Conclusion: It seems that rigid blood glucose control and periodic neurological examinations were the best strategies to prevent DPN.
- Type 1 diabetes mellitus
- NCV
- Diabetic peripheral neuropathy
- HbA1c level
How to Cite
References
Edwards JL, Vincent AM, Cheng HT, Feldman EL. Diabetic neuropathy: mechanisms to management. Pharmacol Ther. 2008 Oct;120(1):1-34.
Incidence and trends of childhood Type 1 diabetes worldwide 1990-1999. Diabet Med. 2006 Aug;23(8):857-66.
Variation and trends in incidence of childhood diabetes in Europe. EURODIAB ACE Study Group. Lancet. 2000 Mar 11;355(9207):873-6.
Soltesz G, Patterson CC, Dahlquist G. Worldwide childhood type 1 diabetes incidence--what can we learn from epidemiology? Pediatr Diabetes. 2007 Oct;8 Suppl 6:6-14.
Silink M. Childhood diabetes: a global perspective. Horm Res. 2002;57 Suppl 1:1-5.
Abbott CA, Carrington AL, Ashe H, Bath S, Every LC, Griffiths J, et al. The North-West Diabetes Foot Care Study: incidence of, and risk factors for, new diabetic foot ulceration in a community-based patient cohort. Diabet Med. 2002 May;19(5):377-84.
Bao XH, Wong V, Wang Q, Low LC. Prevalence of peripheral neuropathy with insulin-dependent diabetes mellitus. Pediatr Neurol. 1999 Mar;20(3):204-9.
Trotta D, Verrotti A, Salladini C, Chiarelli F. Diabetic neuropathy in children and adolescents. Pediatr Diabetes. 2004 Mar;5(1):44-57.
Sajic S, Petrovic R. [Subclinical peripheral neuropathy in type 1 diabetic adolescents and its relationship with metabolic control]. Srp Arh Celok Lek. 2005 Jul-Aug;133(7-8):358-62.
Hasani N, Khosrawi S, Hashemipour M, Haghighatiyan M, Javdan Z, Taheri MH, et al. Prevalence and related risk-factors of peripheral neuropathy in children with insulin-dependent diabetes mellitus. J Res Med Sci. 2013 Feb;18(2):132-6.
Nelson D, Mah JK, Adams C, Hui S, Crawford S, Darwish H, et al. Comparison of conventional and non-invasive techniques for the early identification of diabetic neuropathy in children and adolescents with type 1 diabetes. Pediatr Diabetes. 2006 Dec;7(6):305-10.
Weintrob N, Amitay I, Lilos P, Shalitin S, Lazar L, Josefsberg Z. Bedside neuropathy disability score compared to quantitative sensory testing for measurement of diabetic neuropathy in children, adolescents, and young adults with type 1 diabetes. J Diabetes Complications. 2007 Jan-Feb;21(1):13-9.
Booya F, Bandarian F, Larijani B, Pajouhi M, Nooraei M, Lotfi J. Potential risk factors for diabetic neuropathy: a case control study. BMC Neurol. 2005;5:24.
Riihimaa PH, Suominen K, Tolonen U, Jantti V, Knip M, Tapanainen P. Peripheral nerve function is increasingly impaired during puberty in adolescents with type 1 diabetes. Diabetes Care. 2001 Jun;24(6):1087-92.
Karsidag S, Morali S, Sargin M, Salman S, Karsidag K, Us O. The electrophysiological findings of subclinical neuropathy in patients with recently diagnosed type 1 diabetes mellitus. Diabetes Res Clin Pract. 2005 Mar;67(3):211-9.
Meh D, Denislic M. Subclinical neuropathy in type I diabetic children. Electroencephalogr Clin Neurophysiol. 1998 Jun;109(3):274-80.
Semiz S, Fisenk F, Akcurin S, Bircan I. Temporary multiple cranial nerve palsies in a patient with type 1 diabetes mellitus. Diabetes Metab. 2002 Nov;28(5):413-6.
Malgrange D, Richard JL, Leymarie F. Screening diabetic patients at risk for foot ulceration. A multi-centre hospital-based study in France. Diabetes Metab. 2003 Jun;29(3):261-8.
Smith AG, Ramachandran P, Tripp S, Singleton JR. Epidermal nerve innervation in impaired glucose tolerance and diabetes-associated neuropathy. Neurology. 2001 Nov 13;57(9):1701-4.
Kikkawa Y, Kuwabara S, Misawa S, Tamura N, Kitano Y, Ogawara K, et al. The acute effects of glycemic control on nerve conduction in human diabetics. Clin Neurophysiol. 2005 Feb;116(2):270-4.
Ji N, Zhang N, Ren ZJ, Jia KB, Wang L, Ni JX, et al. Risk factors and pain status due to diabetic neuropathy in chronic long-term diabetic patients in a Chinese urban population. Chin Med J (Engl). 2012 Dec;125(23):4190-6.
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