The Evaluation of Peripheral Neuropathy in Children and Adolescents With Type I Diabetes

Abstract

Diabetic peripheral neuropathy (DPN) is a devastating, long-term complication causing significant morbidity and mortality in adults. Few studies of DPN in children have been done in the United States. Clinicians believe neuropathy to be rare in youth, occurring only in an older population, after many years of diabetes and poor control. The purpose of this study was to evaluate the prevalence of DPN in youth and assess the feasibility of integrating DPN screening into routine diabetes care. Study subjects included two groups: Group 1—8- to 21-year-olds without identified high-risk criteria; Group 2—subjects meeting high-risk criteria: age more than 13 years, diabetes more than 5 years, and HA1c% greater than 10% at two of four visits. Subjects completed a screening inventory composed of a questionnaire and physical examination performed by four providers. Any subject in Group 1 who screened positive was referred to a pediatric neurologist (PN) for nerve conduction studies (NCSs). All subjects in Group 2 were referred to the PN for NCS. Positive NCS was diagnostic of DPN. Diabetes duration, age, race, socioeconomic status, tanner stage, height, blood pressure, and HA1c% were studied in association with peripheral neuropathy. A total of 151 children were screened (Group 1 = 143, Group 2 = 8). In Group 1, 33 (23%) screened positive and were referred to the PN. Of the 24 who agreed to be evaluated by the PN, 11 (46%) were diagnosed with DPN. In Group 2, 6 (75%) screened positive. All 8 high-risk subjects were referred to the PN. Five were evaluated. All 5 were diagnosed with DPN, including one adolescent who screened negative. Of the subjects who screened positive or were high risk, 55.2% had DPN. Of those 16 subjects with DPN, x̄ age was 16.2 years (13.6–19.5), x̄ diabetes duration 6.4 years (3 months to 12 years), and x̄ A1c% 8.7% (7%–12.5%). Screening took approximately 3.5 minutes to complete. DPN is more prevalent in children and adolescents than once considered. We demonstrated that DPN can occur in young children, with short diabetes duration and good control.