Prospective assessment of autonomic and peripheral nerve function in adolescents with diabetes.
Autonomic and peripheral nerve function were studied prospectively in 102 adolescents with Type 1 diabetes over a 5-year period. All adolescents were assessed three times; 54 were assessed four times. The median age at baseline was 14.5 (range 10.4-18.0) yr. The median diabetes duration at baseline was 6.8 (range 1.3-15.2) yr. Autonomic nerve function was assessed by measuring heart rate variation during deep breathing, valsalva manoeuvre, standing from a lying position (30/15 ratio), and the postural change in systolic blood pressure. Peripheral nerve function was assessed by determining the thermal threshold for heat and cold at the wrist and foot and the vibration threshold at the great toe and medial malleolus. At baseline, 29.5% adolescents had at least one abnormal autonomic nerve test and 28.4% had at least one abnormal peripheral nerve test. There was no significant increase in the number of abnormalities over the study period. Persisting abnormalities were present in only six individuals. Abnormalities were not related to age, diabetes duration or glycaemic control. In summary, a low rate of neurological abnormalities was found, suggesting that more than 3 years of follow-up is required to detect evolving neuropathy in this age group.
Donaghue
K C
KC
Ray Williams Institute of Paediatric Endocrinology, Diabetes and Metabolism, Royal Alexandra Hospital for Children, Camperdown, NSW, Australia.
Fung
A T
AT
Fairchild
J M
JM
Howard
N J
NJ
Silink
M
M
D000293:Adolescent; D017668:Age of Onset; D001341:Autonomic Nervous System / Q000503:physiopathology*; D001794:Blood Pressure; D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000503:physiopathology*; D003929:Diabetic Neuropathies / Q000453:epidemiology* / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D005528:Foot / Q000294:innervation; D006442:Glycated Hemoglobin / Q000032:analysis; D006339:Heart Rate; D006801:Humans; D008297:Male; D009460:Neurologic Examination; D010525:Peripheral Nerves / Q000503:physiopathology*; D011187:Posture; D011446:Prospective Studies; D012016:Reference Values; D012044:Regression Analysis; D012119:Respiration; D012307:Risk Factors; D013997:Time Factors; D014034:Toes / Q000294:innervation; D014636:Valsalva Maneuver
D006442:Glycated Hemoglobin