Letter to the Editor in response to “Single sural nerve response: A reliable and practical method for diagnosis of diabetic peripheral neuropathy in children with type 1 diabetes”

To the Editor,

We read with great interest the recent article by Şenol et al.¹ The study presents compelling evidence supporting the efficacy of single sural nerve response assessment in diagnosing diabetic peripheral neuropathy (DPN) in pediatric patients. Given the challenges of conducting nerve conduction studies (NCS) in children, the findings highlight an approach that is not only practical but also clinically valuable.

The authors demonstrated that evaluating a single sural nerve response could achieve a sensitivity of 83.3% and a specificity of 97.2% in diagnosing DPN. This method streamlines the diagnostic process, potentially reducing patient discomfort and increasing compliance. It is noteworthy that their findings align with previous studies that have suggested the sural nerve as an early indicator of diabetic neuropathy, particularly in asymptomatic patients.² Moreover, the study identifies elevated HbA1c as the sole significant predictor of DPN, emphasizing the need for stringent glycemic control to mitigate neuropathic complications.³

However, while the study offers significant clinical implications, a few aspects warrant further discussion. First, given that pediatric patients often present with subclinical neuropathy, longitudinal studies assessing the progression of nerve dysfunction over time would be valuable. Additionally, considering that previous research has indicated the involvement of other sensory nerves in early diabetic neuropathy,⁴ a comparative analysis of different sensory nerves could further refine the diagnostic accuracy of single-nerve testing.

Another important aspect is the practical implementation of this approach in routine clinical settings. The authors suggest that point-of-care devices measuring sural nerve conduction could facilitate earlier diagnosis and intervention.¹ Integrating such devices into primary care settings could help screen for early-stage DPN before significant neurological deficits manifest.

In conclusion, the study by Şenol et al. represents a significant advancement in the early detection of DPN in pediatric type 1 diabetes patients. Future studies should explore broader applications of this method across diverse populations and evaluate its cost-effectiveness in routine clinical practice. We commend the authors for their contribution and look forward to further research in this critical area.

The author declares no conflict of interest.

Approval of the research protocol: N/A.

Informed consent: N/A.

Registry and the registration no. of the study: N/A.

Animal studies: No animal studies or trial was involved.

No funding was received for this work.