Childhood diabetic neuropathy: functional impairment and non-invasive screening assessment
Article first published online: 7 OCT 2012
© 2012 The Authors. Diabetic Medicine © 2012 Diabetes UK
Volume 29, Issue 11, pages 1425–1432, November 2012
How to Cite
Blankenburg, M., Kraemer, N., Hirschfeld, G., Krumova, E. K., Maier, C., Hechler, T., Aksu, F., Magerl, W., Reinehr, T., Wiesel, T. and Zernikow, B. (2012), Childhood diabetic neuropathy: functional impairment and non-invasive screening assessment. Diabetic Medicine, 29: 1425–1432. doi: 10.1111/j.1464-5491.2012.03685.x
- Issue published online: 7 OCT 2012
- Article first published online: 7 OCT 2012
- Accepted manuscript online: 16 APR 2012 10:41AM EST
- Accepted 11 April 2012
Aim Sensory diabetic neuropathy, determined by nerve conduction studies, is common in children with Type 1 diabetes. Diabetic neuropathy diagnoses are rarely made in paediatric daily care because they are asymptomatic, vibration detection is mostly normal and nerve-conduction testing is impractical. The present study aims to: (1) describe somatosensory dysfunction in children with diabetes, (2) test whether diabetes duration and HbA1c are related to somatosensory dysfunction and (3) identify the best screening test for large-fibre dysfunction, as indicated by nerve conduction studies.
Methods Forty-five children (age 13.2 ± 2.5 years) with Type 1 diabetes for 6.7 ± 2.5 years and matched control subjects were assessed by neurological examinations, nerve conduction tests and quantitative sensory testing on the feet using the protocol of the German Research Network on Neuropathic Pain. Abnormal nerve conduction was used as gold standard to define neuropathies.
Results We found a high prevalence of mechanical (38%) and thermal (24%) hypoesthesia often associated with hyperalgesia (47%). Tactile hypoesthesia (33%) was more frequent than pallhypaesthesia (11%). Only cold detection and mechanical pain thresholds were related to HbA1c. Tactile hypoesthesia had the highest sensitivity (75%), specificity (89%) and positive (75%) and negative (89%) predictive values for neuropathies defined by nerve conduction tests (31% abnormal).
Conclusions Almost half of the children with diabetes have subclinical large- and small-fibre neuropathies. Tactile detection was better than vibration for neuropathy assessment. Quantitative sensory testing is a valuable tool for assessment of neuropathy as well as a target of interventional studies in children with diabetes.