OBJECTIVE: To evaluate the prevalence of diabetic polyneuropathy (DNP) in children and adolescents with type 1 diabetes mellitus (DM1), and to compare the diagnostic criteria for DNP proposed and most widely utilized in the literature. METHODS: Forty-eight patients with DM1 with a mean age of 12.9 years and mean duration of DM1 of 7 years, and 14 controls, were compared. Results of clinical neurological examination and nerve conduction (NC) were compared by means of diagnostic criteria proposed at the San Antonio Conference and by Dyck et al. RESULTS: Twenty-two patients (46%) had DNP by the San Antonio criteria, and 25% according to those of Dyck et al. Three patients (6.3%) presented neurological complaints, such as lower limb pain, paresthesia and hyperhidrosis, and 31 (64.6%) presented peripheral nervous system changes upon clinical examination. Twenty-nine patients (60.4%) presented changes in motor and sensory nerve conduction. Motor NC changes were the most prevalent, above all in the median (86.2%) and fibular (55.2%) nerves. CONCLUSIONS: A high percentage of neurological changes were detected in this young population, with 5-10 years duration of DM1. Prevalence of DNP in the pediatric age group ranges from zero to 54% in published studies, mainly using the criteria of Dyck et al. or similar criteria. In the present study we found that roughly one-quarter of patients would be misdiagnosed according to the criteria utilized. We propose that neurological evaluation must be included in routine care for children with DM. Further studies leading to a more accurate diagnosis of DNP in children and adolescents are still necessary.
OBJECTIVE: To evaluate the prevalence of diabetic polyneuropathy (DNP) in children and adolescents with type 1 diabetes mellitus (DM1), and to compare the diagnostic criteria for DNP proposed and most widely utilized in the literature. METHODS: Forty-eight patients with DM1 with a mean age of 12.9 years and mean duration of DM1 of 7 years, and 14 controls, were compared. Results of clinical neurological examination and nerve conduction (NC) were compared by means of diagnostic criteria proposed at the San Antonio Conference and by Dyck et al. RESULTS: Twenty-two patients (46%) had DNP by the San Antonio criteria, and 25% according to those of Dyck et al. Three patients (6.3%) presented neurological complaints, such as lower limb pain, paresthesia and hyperhidrosis, and 31 (64.6%) presented peripheral nervous system changes upon clinical examination. Twenty-nine patients (60.4%) presented changes in motor and sensory nerve conduction. Motor NC changes were the most prevalent, above all in the median (86.2%) and fibular (55.2%) nerves. CONCLUSIONS: A high percentage of neurological changes were detected in this young population, with 5-10 years duration of DM1. Prevalence of DNP in the pediatric age group ranges from zero to 54% in published studies, mainly using the criteria of Dyck et al. or similar criteria. In the present study we found that roughly one-quarter of patients would be misdiagnosed according to the criteria utilized. We propose that neurological evaluation must be included in routine care for children with DM. Further studies leading to a more accurate diagnosis of DNP in children and adolescents are still necessary.
Authors: Mamta Jaiswal; Abigail Lauer; Catherine L Martin; Ronny A Bell; Jasmin Divers; Dana Dabelea; David J Pettitt; Sharon Saydah; Catherine Pihoker; Debra A Standiford; Beatriz L Rodriguez; Rodica Pop-Busui; Eva L Feldman Journal: Diabetes Care Date: 2013-10-21 Impact factor: 19.112