Comparison of conventional and non-invasive techniques for the early identification of diabetic neuropathy in children and adolescents with type 1 diabetes.
BACKGROUND
Neuropathy is an important complication and contributes to the morbidity of diabetes mellitus. The availability of simple and non-invasive tests for screening of early diabetic neuropathy (DN) in children with diabetes may prevent further progression of this complication. The purpose of this study was to compare conventional nerve conduction studies (NCS) with non-invasive techniques, including vibration perception thresholds (VPT) and tactile perception thresholds (TPT) for the detection of DN in children and adolescents with type 1 diabetes.


METHODS
Children from the Alberta Children's Hospital Diabetes Clinic with at least 5 yr duration of type 1 diabetes underwent detailed evaluations, including neurologic exam, NCS, VPT, and TPT testing. Information on duration of diabetes, height, and mean glycosylated hemoglobin (A1C) were also collected. Descriptive statistics, including Student's t-test and chi-squared test, were used for analysis.


RESULTS
Seventy-three children (mean age of 13.7+/-2.6 yr) completed the study. The mean duration of diabetes was 8.1+/-2.6 yr, and the mean A1C was 9.0+/-1.0%. Forty-two (57%) children had DN based on NCS. Using NCS as a gold standard, the sensitivity and specificity of VPT were 62 and 65%, while the sensitivity and specificity of TPT were 19 and 64%, respectively.


CONCLUSIONS
Subclinical DN is common among children and adolescents with type 1 diabetes, and there is a need for better metabolic control in this population. VPT and TPT may not be adequate screening tools for the detection of DN in children.
Nelson
Danielle
D
Division of Endocrinology, Department of Pediatrics, University of Calgary, Alberta Children's Hospital, Calgary, AB, Canada.
Mah
Jean K
JK
Adams
Coleen
C
Hui
Stephanie
S
Crawford
Susan
S
Darwish
Husam
H
Stephure
David
D
Pacaud
Danièle
D
D000293:Adolescent; D000416:Alberta; D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000150:complications*; D003929:Diabetic Neuropathies / Q000175:diagnosis* / Q000453:epidemiology; D003943:Diagnostic Techniques, Neurological; D006801:Humans; D008403:Mass Screening; D008475:Median Nerve / Q000503:physiopathology; D009046:Motor Neurons / Q000502:physiology*; D009431:Neural Conduction / Q000502:physiology; D010543:Peroneal Nerve / Q000503:physiopathology; D013497:Sural Nerve / Q000503:physiopathology