M Louraki1, C Tsentidis2, D Kallinikou2, M Katsalouli3, C Kanaka-Gantenbein4, N Kafassi5, A Papathanasiou6, K Karavanaki7. 1. Diabetic Clinic, Second Pediatric Department University of Athens, "P&A Kyriakou" Children's Hospital, Athens, Greece. Electronic address: mlouraki@hotmail.com. 2. Diabetic Clinic, Second Pediatric Department University of Athens, "P&A Kyriakou" Children's Hospital, Athens, Greece. 3. Neurologic Department, "Aghia Sophia" Children's Hospital, Athens, Greece. 4. Diabetes Center, Division of Endocrinology, Diabetes and Metabolism, First Department of Pediatrics, University of Athens, "Aghia Sophia" Children's Hospital, Athens, Greece. 5. Department of Immunology, 'Laiko' General Hospital, Greece. 6. Department of Pediatric Endocrinology, "P&A Kyriakou" Children's Hospital, Athens, Greece. 7. Diabetic Clinic, Second Pediatric Department University of Athens, "P&A Kyriakou" Children's Hospital, Athens, Greece. Electronic address: kkarav@yahoo.gr.
Abstract
AIMS: To define the reproducibility of vibration perception thresholds (VPTs) and the possible associated factors, as an early index of peripheral diabetic neuropathy (PDN) in type 1 diabetes mellitus (T1DM) children and adolescents. METHODS: A single examiner studied 118 T1DM subjects (aged 13.5±3.4 years) and 79 controls (aged 12.0±3.07 years). Glycaemic control was assessed with HbA1c levels. VPT was measured twice on upper and lower limbs, using a Biothesiometer. Concordance between the two VPT measurements was evaluated using the Cohen's Weighted Kappa statistic (Kappa=0.41-0.60→moderate concordance, Kappa=0.61-0.80→substantial concordance). RESULTS: T1DM children had significantly higher VPTs than controls at all sites (p=0.001), but with lower Kappa values (0.64-0.70). VPT values increased in parallel with HbA1c (a.<8%, b. 8-9.5%, c.>9.5%) and T1DM duration (a.<5 years, b.5.1-10, c.>10 years). However, Kappa values were lower in the groups with the poorest control (HbA1c>9.5%) (Kappa=0.54-0.76) or the longest T1DM duration (>10 years) (Kappa=0.49-0.71). Although VPTs increased with stature and male gender, no effect on VPT reproducibility was observed. However, obesity was associated with lower VPT values and poorer concordance. CONCLUSIONS: These findings suggest that the reproducibility of VPTs is lower in the high-risk patients for early subclinical PDN development, who need a regular follow-up.
AIMS: To define the reproducibility of vibration perception thresholds (VPTs) and the possible associated factors, as an early index of peripheral diabetic neuropathy (PDN) in type 1 diabetes mellitus (T1DM) children and adolescents. METHODS: A single examiner studied 118 T1DM subjects (aged 13.5±3.4 years) and 79 controls (aged 12.0±3.07 years). Glycaemic control was assessed with HbA1c levels. VPT was measured twice on upper and lower limbs, using a Biothesiometer. Concordance between the two VPT measurements was evaluated using the Cohen's Weighted Kappa statistic (Kappa=0.41-0.60→moderate concordance, Kappa=0.61-0.80→substantial concordance). RESULTS: T1DM children had significantly higher VPTs than controls at all sites (p=0.001), but with lower Kappa values (0.64-0.70). VPT values increased in parallel with HbA1c (a.<8%, b. 8-9.5%, c.>9.5%) and T1DM duration (a.<5 years, b.5.1-10, c.>10 years). However, Kappa values were lower in the groups with the poorest control (HbA1c>9.5%) (Kappa=0.54-0.76) or the longest T1DM duration (>10 years) (Kappa=0.49-0.71). Although VPTs increased with stature and male gender, no effect on VPT reproducibility was observed. However, obesity was associated with lower VPT values and poorer concordance. CONCLUSIONS: These findings suggest that the reproducibility of VPTs is lower in the high-risk patients for early subclinical PDN development, who need a regular follow-up.