Role of Height and Glycosylated Hemoglobin in Abnormal Nerve Conduction in Pediatric Patients With Type I Diabetes Mellitus After 4–9 yr of Disease

Duck, Stephen C.; Wei, Feifei; Parke, Julie T.; Swick, Herbert M.

doi:10.2337/diacare.14.5.386

Cited by 33 publications

(33 citation statements)

References 11 publications

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“…Sensory nerve conduction (SCV and SNAP) was less often affected. This distribution is similar to the one found in adult patients with diabetic neuropathy [8,33,34] and in children with IDDM [16,21]. Earlier studies in adults with overt diabetic neuropa-L. Hyllienmark et al: Subclinical nerve dysfunction thy have suggested that sensory nerve fibres are affected before motor fibres [33,35].…”

Section: Discussionsupporting

confidence: 60%

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Subclinical nerve dysfunction in children and adolescents with IDDM

1995

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SummaryThe purpose of this study was to investigate whether young insulin-dependent diabetic patients still develop peripheral nerve dysfunction when using modern multiple insulin injection therapy and to elucidate if this correlated with various disease parameters. Seventy-five patients, 7 to 20 years old with a duration of diabetes of more than 3 years, and 128 age-matched healthy control subjects underwent bilateral studies of median, peroheal, and sural nerves. Presence of diabetes lowered motor conduction velocity (p < 0.0001), sensory conduction velocity (p < 0.0001) and sensory nerve action potential (p < 0.05) in all examined nerves. The mean change in conduction velocity induced by diabetes was -4.8 m/s in the peroneal nerve, -3.3 m/s in the median motor nerve, -2.6 m/s in the sural nerve and -2.4 m/s in the median sensory nerve. Fifty-seven percent of the patients had abnormal conduction (values outside 95 % predictive interval) which was seen most often in the motor nerves, especially in the peroneal nerve (41%) followed by the median nerve (24 %). In multiple regression analysis, longterm poor metabolic control and increased body length correlated with nerve dysfunction identified in most examined parameters. Three patients had signs or symptoms suggestive of neuropathy. It is concluded that despite modern multiple insulin injection therapy, with reasonably good metabolic control, nerve dysfunction is still common in children and adolescents with insulin-dependent diabetes mellitus. Risk factors are increased height and long-term poor metabolic control. [Diabetologia (1995) 38: 685-692] Key words Insulin-dependent diabetes mellitus, children, neuropathy, nerve conduction velocity, glycaemic control, height.Peripheral neuropathy is a common complication of insulin-dependent diabetes mellitus (IDDM) [1], which increases in frequency with the duration of disease [2][3][4] and is uncommon in children [5]. Although Received: 3 October 1994 and in revised form: 2 December 1994Corresponding author: Dr. L. Hyllienmark, Department of Clinical Neurophysiology, University Hospital, S-58185 Link6ping, Sweden Abbreviations: IDDM, Insulin-dependent diabetes mellitus; MIT, multiple insulin injection therapy; MCV, motor nerve conduction velocity; CMAR compound muscle action potential; DML, distal motor latency; SCV, sensory nerve conduction velocity; SNAP, sensory nerve action potential. unproven, we assume that overt neuropathy with symptoms is preceded by a subclinical form which is important to detect and describe. Electrophysiological studies of nerve conduction velocity are probably our most sensitive tools to quantify early abnormalities [6][7][8]. Such studies exist in paediatric patients on conventional treatment [9-22] but not in patients on modern multiple insulin injection therapy (MIT). The benefits of using MITwith tight metabolic control on diabetic late complications have been clearly shown [23][24][25][26]. The aim of the present study was to ascertain whether young IDDM patients using MIT still d...

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Section: Discussionsupporting

confidence: 60%

“…It is noteworthy that only 3 of the 75 patients had any signs or symptoms of neuropathy. A decrease in both MCV and SCV has previously been demonstrated in children and adolescents with IDDM [14,16,21]. However, this is the first study in which all patients have received MIT-treatment.…”

Section: Discussionmentioning

confidence: 84%

Subclinical nerve dysfunction in children and adolescents with IDDM

1995

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“…Puberty is likely to be one of the most critical periods for the development of peripheral nerve dysfunction in patients with type 1 diabetes because of various hormonal changes affecting glycemic control during puberty (8). The Tanner stages of pubertal maturation (9) have rarely been considered in studies on peripheral polyneuropathy in young patients with type 1 diabetes (4,10), and there is a need for additional knowledge of the role of puberty in the development of such abnormalities. The purpose of this cross-sectional study was to assess clinically and neurophysiologically the signs of damage to the peripheral nerve system observed in a large series of adolescent patients with type 1 diabetes in relation to pubertal maturation.…”

mentioning

confidence: 99%

“…Poor metabolic control has a negative impact on NCV and on nerve amplitude (4) and is an independent risk factor for symmetric distal DP (7). Puberty is likely to be one of the most critical periods for the development of peripheral nerve dysfunction in patients with type 1 diabetes because of various hormonal changes affecting glycemic control during puberty (8).…”

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confidence: 99%

Peripheral Nerve Function Is Increasingly Impaired During Puberty in Adolescents With Type 1 Diabetes

Riihimaa

Suominen²,

Tolonen³

et al. 2001

Diabetes Care

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OBJECTIVE -To evaluate the impact of puberty on peripheral nerve function in adolescents with type 1 diabetes.RESEARCH DESIGN AND METHODS -Of 138 eligible patients with type 1 diabetes, 100 patients (age Ͼ9 years and diabetes duration Ͼ2 years) attending an outpatient diabetes clinic and 100 age-and sex-matched healthy control subjects took part in this cross-sectional study. Peripheral motor and sensory nerve conduction tests, cardiovascular reflex tests on the autonomic nervous system, and measurements of vibration-perception threshold (VPT) were performed.RESULTS -Nerve conduction velocity (NCV) in the distal motor and sensory nerves, the motor nerve distal latency, and the sensory nerve action potential (SNAP) amplitude were impaired in the adolescent patients with type 1 diabetes. The deterioration in motor NCV, H-reflex latency, and SNAP amplitude became more conspicuous in late puberty and postpuberty and was related to poor metabolic control. A total of 10 patients had distal diabetic polyneuropathy (DP) neurophysiologically, and these patients had significantly lower heart-rate variation in the deep breathing test than the other patients. Three of the patients with DP had peripheral neurological signs or symptoms. A slight difference in the VPT between the patients and control subjects was observed after puberty.CONCLUSIONS -Increasing subclinical motor nerve impairment can be detected during late puberty and after puberty, and sensory NCV and SNAP amplitude are reduced in adolescents with type 1 diabetes. Poor metabolic control during puberty appears to induce deteriorating peripheral neural function in young patients with type 1 diabetes.

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“…Studies using objective measures of nerve dysfunction (eg, nerve conduction studies [NCS]) demonstrated abnormalities in 28% to 58% of children with diabetes [1][2][3][4] and categorized them as high risk for developing severe secondary complications such as foot ulcerations. 5 These severe complications can only be averted when signs of the disease are detected early.…”

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confidence: 99%

Screening for Peripheral Neuropathies in Children With Diabetes: A Systematic Review

et al. 2014

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BACKGROUND AND OBJECTIVE: Although guidelines for the management of children with type 1 diabetes include recommendations to screen for diabetic peripheral neuropathies (DPN), the research into the diagnostic utility of screening methods has not been systematically reviewed. The goal of this study was to summarize the findings with regard to the diagnostic accuracy of the Semmes-Weinstein monofilament and the Rydel-Seiffer tuning fork in detecting DPN in children and adolescents compared with the gold standard nerve conduction studies. METHODS:Based on a PubMed search (conducted on April 26, 2013) and secondary searching, we identified 72 articles for review. We included studies that: (1) assessed DPN with the gold standard nerve conduction studies; (2) used noninvasive screening for DPN (monofilament, tuning fork, or biothesiometer); and (3) were performed in the relevant population (children with diabetes). Five articles met these criteria. Study quality was assessed by using the revised Quality Assessment of Diagnostic Accuracy Studies criteria. Heterogeneous methods precluded a formal meta-analysis of effects.RESULTS: Diagnostic accuracies were heterogeneous for the different screening methods. Sensitivities ranged from 1% to 19% for the tuning fork (3 studies); from 61% to 80% for the biothesiometer (2 studies); and from 19% to 73% for the monofilament (2 studies).CONCLUSIONS: Data show extremely low diagnostic utility for standard screening methods (tuning fork and 10-g monofilament) but acceptable utilities for biothesiometry and finer (1 g) monofilaments. Data on the diagnostic utility should be used to inform national and international guidelines on diabetes management.

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Role of Height and Glycosylated Hemoglobin in Abnormal Nerve Conduction in Pediatric Patients With Type I Diabetes Mellitus After 4–9 yr of Disease

Cited by 33 publications

References 11 publications

Subclinical nerve dysfunction in children and adolescents with IDDM

Subclinical nerve dysfunction in children and adolescents with IDDM

Peripheral Nerve Function Is Increasingly Impaired During Puberty in Adolescents With Type 1 Diabetes

Screening for Peripheral Neuropathies in Children With Diabetes: A Systematic Review

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