Presence of neuropathy in children and adolescents with type 1 diabetes evaluated with bedside modalities

Aims

To investigate the prevalence of diabetic polyneuropathy (DPN), cardiac autonomic neuropathy (CAN) and sudomotor dysfunction in children and adolescents with type 1 diabetes using bedside modalities. Secondly, to evaluate the co-existence of these types of diabetes neuropathies.

Methods

Cross-sectional study including 221 children and adolescents with type 1 diabetes. DPN was assessed by vibration sensation threshold and sural nerve conductance, CAN by cardiac reflex tests and sudomotor function by electrochemical skin conductance.

Results

Median (interquartile range) age was 14.2 (11.9, 16.5) years, diabetes duration 4.8 (2.7, 7.7) years and Hba1c 7.1 (6.6, 7.9) %, (54: 49, 63 mmol/mol). Three had retinopathy; all had normal albuminuria. DPN was present in 40 %, early CAN in 17 %, established CAN in 3 % and sudomotor dysfunction in the feet in 5 %. Of these, 60 % had one type of neuropathy, while 35 % had two types. Only 1 participant manifested all three types of neuropathies.

Conclusions

Bedside modalities demonstrated a high prevalence of neuropathy in children and adolescents with type 1 diabetes, despite good glycemic outcome, short diabetes duration and absence of complications. A lack of co-existing neuropathies was shown, underscoring the need for multiple screening modalities.