Diabetic Neuropathy in Children and Adolescents – a Prospective 5‑year Study

Czech version

Authors: G. Hajaš ¹; J. Jakubička ²
Authors‘ workplace: FSVaZ UKF a FN Nitra Neurologická klinika ¹; FSVaZ UKF a FN Nitra Pediatrická klinika ²
Published in: Cesk Slov Neurol N 2010; 73/106(1): 51-56
Category: Original Paper

Overview

Introduction:
Diabetic neuropathy is the most commonly occurring chronic complication of diabetes, the onset of which depends largely on the duration of the disease. The prevalence of diabetic neuropathy in adult diabetics is estimated at more than 30%; however, the symptomatic forms of neuropathy in children and adolescents with DM are considered rare.

Aim:
To determine the occurrence of diabetic neuropathy in a definite sample of patients and to investigate whether children and adolescents with type 1 DM still develop peripheral nerve dysfunction despite using modern multiple insulin injection therapy. Methods: 72 young diabetics with type 1 DM were progressively entered into a 5-year prospective study in the years 2001–2003. All patients were treated with modern multiple insulin injection therapy. A total of 66 patients finished the study (92%). Average age was 14.2 years at study entrance; average duration of diabetes at the beginning was 5.4 years. All patients were given a detailed clinical neurological examination, including tactile perception, vibratory perception and electromyographia.

Results:
Despite multiple insulin injection therapy, there was an increase of the occurrence of diabetic neuropathy from 24.2 to 42.4% during the 5-year follow-up period. The proportion of patients with asymptomatic (subclinical) neuropathy increased from 13.6 to 25.7% and that of patients with symptomatic (clinical) neuropathy increased from 10.6 to 16.7%. Among the electrophysiological investigations, the highest sensitivity was found in the conduction velocity of the tibial nerve (abnormal in 35% of patients), followed by the conduction velocity of the peroneal and sural nerves.

Conclusion:
Young diabetics develop mainly subclinical forms of neuropathy, an unusually important finding in the light of prevention. This study is one of the few that are concerned with the longitudinal follow-up of neuropathy in young diabetics.

Key words:
diabetes mellitus, type 1 – diabetic neuropathy – early diagnosis – electromyography

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