Impact of Neuropathy on Well-Being and Health-Related Quality of Life in Adolescents With Type 1 Diabetes.

Aim: This study is aimed at assesing the impact of neuropathy on well-being and health-related quality of life (HRQoL) in adolescents with Type 1 diabetes (T1D). Methods: In a cross-sectional study, 60 adolescents with T1D (15-18 years, diabetes duration > 5 years) were enrolled. Clinical and biochemical data were collected, and well-being and HRQoL were assessed using the WHO-5 well-being index and DISABKIDS questionnaires, including diabetes-specific modules. Diagnostic tests for large fiber neuropathy (LFN), small fiber neuropathy (SFN), and autonomic neuropathy were performed as part of the T1DANES study. The participants were divided into groups depending on the presence or absence of specific forms of neuropathy. Those with autonomic neuropathy were further divided depending on reported autonomic symptoms (Composite Autonomic Symptom Scale 31 (COMPASS-31) score ≥ 24 or < 24). Additionally, the data was compared to 23 healthy control subjects. Results: The median diabetes duration was 8.5 years (range 5-17), and the HbA1c was 60 mmol/mol (7.6%) (range 41-93 [5.9%-10.6%]). Adolescents who had abnormal autonomic function test(s) and a COMPASS-31 score ≥ 24 exhibited lower WHO-5 well-being index compared to the following groups: those with abnormal autonomic test(s) and fewer autonomic symptoms (COMPASS-31 < 24), the remaining adolescents with T1D, and the control subjects (p values < 0.05). There was no significant difference in the total score of DISABKIDS between the groups; however, the subdomain social inclusion was lowest in the group with COMPASS-31 ≥ 24. Gastric motility index (p = 0.04) and uroflow acceleration (p = 0.02) were positively associated with the total score of DISABKIDS. Females reported lower well-being and HRQoL than males (p values < 0.05); in total, 28% had a WHO-5 well-being index < 50. Conclusion: In conclusion, adolescents with diabetic autonomic neuropathy who also reported autonomic symptoms had lower well-being and impaired social inclusion. Adolescents with symptoms of neuropathy and females appear to be at higher risk of lower well-being, and using standardized screening tools helps to identify the subjects at risk.