Peripheral sensory nerve dysfunction in children and adolescents with Type 1 diabetes mellitus

Abstract

The aim of the present study was to investigate peripheral sensory nerve function in diabetic children and adolescents without neurological symptoms. Ninety-two children and adolescents with Type 1 (insulin-dependent) diabetes mellitus (mean +/- SD age: 14.2 +/- 2.1 years, diabetes duration: 5.8 +/- 3.0 years) and 80 healthy control subjects (age: 13.8 +/- 2.2 years) matched for age, sex, body mass index, and height standard deviation score were involved in the study. Using a sine-wave transcutaneous stimulator, current perception threshold (CPT) testing at 2000, 250 and 5 Hz was performed on the left median and peroneal nerves. Diabetic children had increased CPT at 2000 Hz on both nerves as compared to the control group (median (interquartile range), median nerve: 2.43 (2.20-3.43) vs 1.80 (1.51-2.60) mA, p = 0.02; peroneal nerve: 3.51 (2.81-4.82) vs 2.70 (2.04-3.70) mA, p = 0.01). Twenty-one (23%) of patients had CPT values higher than that of any healthy individual. Of these, elevated CPT was observed in 9 (9.8%) patients on the median nerve, in 8 (8.7%) patients on the peroneal nerve, and in 4 (4.3%) patients on both median and peroneal nerves. Using multiple logistic regression analysis, worse long-term metabolic control and advanced puberty were independently predictive of peripheral sensory nerve dysfunction as the dependent variable (adjusted OR (95% CI): 3.4 (1.2-6.2), p = 0.01, and 2.8 (1.1-5.6), p = 0.03, respectively). In conclusion, evidence of peripheral sensory nerve dysfunction is not rare in children and adolescents with diabetes and can be demonstrated by CPT testing in asymptomatic patients. Poor metabolic control is a risk factor for such subclinical neuropathy, and pubertal development may be involved in the pathogenesis of diabetic peripheral neuropathy.

Prevalence of Diabetes Complications in Adolescents With Type 2 Compared With Type 1 Diabetes

“…Abnormalities in peripheral nerve function were common in patients with type 1 and type 2 diabetes (27 and 21%, respectively) based on quantitative sensory tests. The rate in type 1 diabetes is consistent with data from other authors (48,49) but is considerably lower than the rate of 63% in Danish patients screened in 1995 (38). In the latter study, risk factors for neuropathy included age, male sex, and elevated AER.…”

Pudendal and median nerve sensory perception threshold: A comparison between normative studies

“…Several studies mentioning normative data (Barkai et al 1998;Kenton et al 2003) using the median and range of values, which indicates a large variability, could not be used because of incomplete data.…”

Type 1 diabetes and cardiovascular disease

“…Several studies confirmed the association between poor glycemic control and an increasing risk for nephropathy [100-102], retinopathy [95,103,104], and neuropathy [105-109]. A large proportion of patients, however, fails to achieve glycemic targets [110-112].…”