Clinical manifestations of peripheral vegetative insufficiency in children and adolescents with type 1 diabetes mellitus (retrospective and prospective investigations)

Abstract

The variety of complications of type 1 diabetes mellitus (DM) in children and adolescents are often observed in clinical practice. Among them, damage to the central and peripheral nervous system prevails. The term «peripheral vegetative insufficiency» (PVI) refers to a complex of vegetative manifestations that occur in the peripheral (segmental) part of the VNS against the DM background. Objective — to determine the clinical typology of PVN in children with type 1 DM during the period of the years 1980—1990 (retrospective investigation) and in the period of the years 2012—2022 (prospective study). Materials and methods. The study was conducted on the basis of the Department of Endocrinology of the SI «Institute of Child and Adolescent Health of the NAMS of Ukraine». Examinations involved 605 pediatric patients: 285 patients (126 children and 159 adolescents) in the retrospective study, and 320 subjects (186 children and 134 adolescents) in the group of prospective study. All patients underwent somatic, neurological, and clinical examinations. Results and discussion. It haі been determined that in children and adolescents with type 1 diabetes mellitus, PVI clinical manifestations were present in all physiological body systems and often occur under the mask of various somatic diseases. The most typical PVI clinical syndromes in pediatric patients with DM included orthostatic hypotension, tachycardia at rest, hypohidrosis, gastroparesis, constipation, and urinary incontinence. The incidence of PVI syndromes in the groups of patients in the prospective study (years 2012-2022) was lower than in the retrospective study (years 1980—1990) owing to the use of the novel technologies for the DM treatment. Conclusions. The labile, severe course of type 1 diabetes mellitus in children often triggers the development of autonomic disorders, which are predictors and manifestations of neurological disorders. As the overall duration of the disease increases and carbohydrate metabolism is not compensated properly, the number of functional organic neurological complications increases. Damage to immature brain structures affects their further development and forms the basis for the long-term neurological complications in older age.