title: Childhood diabetic neuropathy: functional impairment and non-invasive screening assessment.
abstract: OBJECTIVE
  Sensory diabetic neuropathy, determined by nerve conduction studies, is common in children with Type 1 diabetes. Diabetic neuropathy diagnoses are rarely made in paediatric daily care because they are asymptomatic, vibration detection is mostly normal and nerve-conduction testing is impractical. The present study aims to: (1) describe somatosensory dysfunction in children with diabetes, (2) test whether diabetes duration and HbA(1c) are related to somatosensory dysfunction and (3) identify the best screening test for large-fibre dysfunction, as indicated by nerve conduction studies.
  
  
  METHODS
  Forty-five children (age 13.2 ± 2.5 years) with Type 1 diabetes for 6.7 ± 2.5 years and matched control subjects were assessed by neurological examinations, nerve conduction tests and quantitative sensory testing on the feet using the protocol of the German Research Network on Neuropathic Pain. Abnormal nerve conduction was used as gold standard to define neuropathies.
  
  
  RESULTS
  We found a high prevalence of mechanical (38%) and thermal (24%) hypoesthesia often associated with hyperalgesia (47%). Tactile hypoesthesia (33%) was more frequent than pallhypaesthesia (11%). Only cold detection and mechanical pain thresholds were related to HbA(1c). Tactile hypoesthesia had the highest sensitivity (75%), specificity (89%) and positive (75%) and negative (89%) predictive values for neuropathies defined by nerve conduction tests (31% abnormal).
  
  
  CONCLUSIONS
  Almost half of the children with diabetes have subclinical large- and small-fibre neuropathies. Tactile detection was better than vibration for neuropathy assessment. Quantitative sensory testing is a valuable tool for assessment of neuropathy as well as a target of interventional studies in children with diabetes.
authors.affiliation: Vodafone Foundation Institute and Chair for Children's Pain Therapy and Paediatric Palliative Care, Clinic for Children and Adolescents, Witten/Herdecke University, Datteln, Germany. m.blankenburg@kinderklinik-datteln.de
authors.forename: M
authors.initials: M
authors.lastname: Blankenburg
authors.forename: N
authors.initials: N
authors.lastname: Kraemer
authors.forename: G
authors.initials: G
authors.lastname: Hirschfeld
authors.forename: E K
authors.initials: EK
authors.lastname: Krumova
authors.forename: C
authors.initials: C
authors.lastname: Maier
authors.forename: T
authors.initials: T
authors.lastname: Hechler
authors.forename: F
authors.initials: F
authors.lastname: Aksu
authors.forename: W
authors.initials: W
authors.lastname: Magerl
authors.forename: T
authors.initials: T
authors.lastname: Reinehr
authors.forename: T
authors.initials: T
authors.lastname: Wiesel
authors.forename: B
authors.initials: B
authors.lastname: Zernikow
mesh_terms: D000293:Adolescent; D017668:Age of Onset; D002648:Child; D003080:Cold Temperature; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000503:physiopathology*; D003929:Diabetic Neuropathies / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology*; D004594:Electrophysiology / Q000379:methods*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006358:Hot Temperature; D006801:Humans; D006930:Hyperalgesia / Q000175:diagnosis / Q000503:physiopathology*; D006987:Hypesthesia / Q000175:diagnosis / Q000503:physiopathology*; D008297:Male; D009431:Neural Conduction; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D012684:Sensory Thresholds; D014110:Touch; D014732:Vibration
chemical_list: D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human