Diabetic neuropathy in children and adolescents

Abstract

Diabetic neuropathy (DN) represents a major complication of type 1 diabetes mellitus (T1DM) but there is considerable uncertainty as to its incidence, prevalence, diagnosis and prognosis in pediatric population. Generally, DN is classified as polyneuropathy, focal neuropathy and autonomic neuropathy. The latter seems to be detectable even in asymptomatic children and adolescents with diabetes and is associated with the most serious consequences, such as hypoglycemia unawareness and cardiovascular dysfunction. A near-normal control of blood glucose in the early years after onset of diabetes may delay the development of clinically significant nerve impairment and, therefore, children and adolescents with diabetes represent a critical target for primary prevention of this complication. The aim of this review is to focus on the main clinical, epidemiological and prognostic aspects of DN in children and adolescents with T1DM. Etiopathogenetic theories and diagnostic tools are also reviewed from in a pediatric perspective.

Microvascular disease in children and adolescents with type 1 diabetes and obesity

“…In epidemiological studies involving young people with T1D, the percentage of subjects affected by peripheral diabetic neuropathy ranged from 9 to 58% [34], with variations depending on the different cohorts of patients studied, different testing modalities and different criteria and cut off values.…”

“…Diabetic neuropathy is defined by a clinical or subclinical disorder, without any additional causes of peripheral neuropathy other than diabetes, and can be either somatic or autonomic [34]. Chronic distal symmetric polyneuropathy is the most common form of diabetic neuropathy and is characterized by symmetric damage of peripheral small sensory and large motor nerve fibers [35].…”

Validity of the Neurological Examination in Diagnosing Diabetic Peripheral Neuropathy

“…This uncertainty is probably because of the lack of large epidemiologic studies, the definition chosen for the presence of DPN, and the methodology used to assess its presence [4]. The International Society for Pediatric and Adolescent Diabetes periodically issues clinical practice consensus guidelines for screening for vascular complications [5].…”

Microvascular and Macrovascular Complications in Children and Adolescents with Type 1 Diabetes

“…Data on autonomic neuropathy indicate a prevalence ranging from 14% to 75%, with a high number of youth with type 1 diabetes presenting suclinical signs of autonomic dysfunction, even after a short duration of T1D. This variability across different studies is mainly related to differences in the characteristics of the study cohorts as well as to the use of different testing modalities and different criteria and cut off values (Trotta et al, 2004;Verrotti et al, 2009). …”