Electrophysiological Characterization of Neuropathy Complicating Type 1 Diabetes Mellitus

Abstract

Diabetic peripheral neuropathy (DPN) involves sensory and motor nerves, resulting in demyelination as well as axonal degeneration. This study was conducted to describe the pattern of lower limb nerve involvement in children with type 1 diabetes mellitus (DM) based on the parameters of nerve conduction study (NCS). This cross-sectional study recruited 50 children with type 1 DM having mean disease duration of 4.92±3.84 years who attended the referred clinic in Sudan Childhood Diabetes Center. Their mean age was 15.00±2.19 years, 42% were males, and 58% were females. Twenty six matched healthy control subjects were involved; their mean age was 13.88±2.46 years, 38.46% were males, and 61.54% were females. Bilateral NCS of the sensory and motor lower limb nerves was performed using Medelec Synergy machine. Interpretation of the patients’ results was based on our own control reference values. Data was analysed using IBM SPSS statistics. Out of the 50 diabetic patients, 44 (88%) had electrophysiological evidence of peripheral neuropathy (abnormalities in at least two of the electrophysiological parameters). The majority (68.2%) had motor involvement and 31.8% had sensorimotor, while none of them (0%) had pure sensory involvement. Regarding abnormal NCS parameters (conduction velocity vs. amplitude of the compound action potential), conduction slowing feature predominated in 61.4% and only few (6.8%) showed amplitude reduction, while 31.8% showed mixed features. The most frequently affected nerve was the common peroneal, followed by posterior tibial, and the least was the sural nerve. The most sensitive parameter was the common peroneal conduction velocity. Motor precedes sensory nerve involvement. The most frequent neurophysiological abnormality was the conduction slowing, and the common peroneal was the most vulnerable nerve. These findings signify generation of a protocol for early screening of neuropathy in children with type 1 diabetes.

Redefining distal symmetrical polyneuropathy features in type 1 diabetes: a systematic review

“…Few studies described the neurophysiological profile of a predominantly sensory axonal polyneuropathy [64][65][66]. Three studies revealed that NCS abnormalities in motor nerves were more frequent than changes in sensory nerves [60,67,68]. Two of these studies also analyzed T2DM patients and showed greater impairment of motor nerve parameters in T1DM compared with T2DM, without significant differences in sensory parameters.…”

“…Though ankle reflexes assessment was the most commonly used bedside clinical examination test to assess and screen for T1DM-related DSPN, only 9 studies reported the frequency of ankle reflexes absence or reduction, ranging between 2 and 75% in patients with diabetic DSPN. The two studies reporting the lowest prevalence of ankle reflexes abnormalities (2–15%) included only pediatric patients [ 60 , 61 ], but other studies on pediatric patients found abnormalities in high percentages of patients (65–75%) [ 50 , 62 ].…”

“…Detailed NCS studies described T1DM-related DSPN as a predominantly length-dependent sensory axonal polyneuropathy, similar to T2DM-related DSPN [ 64 – 66 ]. Interestingly, several studies showed more prominent NCS abnormalities in motor nerves compared with sensory nerves [ 60 , 67 , 68 ], and early motor unit loss as assessed by MUNE being present at preclinical stages of T1DM-related DSPN [ 69 , 70 ]. Furthermore, two studies showed greater impairment of motor nerve parameters in T1DM-related DSPN compared with T2DM-related DSPN, without significant differences in sensory parameters [ 67 , 68 ].…”

A Social Marketing Intervention to Improve Treatment Adherence in Patients with Type 1 Diabetes

“…Therefore, there is information that may support Hypothesis 2. Notes: p-value under 0.025 implies significant differences between both measurements, 1 Blood Glucose Monitoring Frequency (BGMF), 2 Blood Glucose Average (BGA), 3 Hypoglycaemia frequency (HypoF), 4 Hyperglycaemia frequency (HyperF), 5 Haemoglobin A1c levels (HbA1c). b Based on negative ranks.…”

“…People with diabetes have a high probability of developing serious heart ailments and infections. Following long-duration diabetes, microvascular and macrovascular complications occur [ 2 ]. Currently, T1DM cannot be prevented, although it can be controlled by adhering to a prescribed treatment protocol (insulin, diet, exercise and self-monitoring).…”