title: Validity of the neurological examination in diagnosing diabetic peripheral neuropathy.
abstract: The aim of this study was to evaluate the prevalence of diabetic peripheral neuropathy in children and adolescents with type 1 diabetes mellitus and examine whether the neurological examination validly diagnoses diabetic peripheral neuropathy as compared with the gold standard of nerve conduction velocity in these patients. Nerve conduction velocity was measured in an unselected consecutive series of patients aged 8-18 years who had been suffering from type 1 diabetes mellitus for at least 1 year. For the neurological examination, neuropathy disability scores and neuropathy sign scores were used. Of the 39 patients, six (15%) had clinically evident diabetic peripheral neuropathy, whereas nerve conduction velocity testing revealed diabetic peripheral neuropathy in 15 (38%) patients. Sensitivity and specificity of the neurological examination for the diagnosis of diabetic peripheral neuropathy were 40% and 100%, respectively. The corresponding positive and negative predictive values were 100% and 72.7%, respectively. This conclusions from this study are that in children and adolescents with type 1 diabetes mellitus, diabetic peripheral neuropathy is highly prevalent, but in the majority of patients it is subclinical. Sensitivity and negative predictive values of the neurological examination are low. Therefore, routine nerve conduction velocity measurement for the assessment of diabetic peripheral neuropathy appears to be warranted in these patients.
authors.affiliation: Department of Pediatrics, Academic Teaching Hospital, Landeskrankenhaus Feldkirch, Austria.
authors.forename: Isabella
authors.initials: I
authors.lastname: Höliner
authors.forename: Vera
authors.initials: V
authors.lastname: Haslinger
authors.forename: Jürg
authors.initials: J
authors.lastname: Lütschg
authors.forename: Guido
authors.initials: G
authors.lastname: Müller
authors.forename: Daniela Seick
authors.initials: DS
authors.lastname: Barbarini
authors.forename: Jörg
authors.initials: J
authors.lastname: Fussenegger
authors.forename: Ulrike
authors.initials: U
authors.lastname: Zanier
authors.forename: Christoph H
authors.initials: CH
authors.lastname: Saely
authors.forename: Heinz
authors.initials: H
authors.lastname: Drexel
authors.forename: Burkhard
authors.initials: B
authors.lastname: Simma
mesh_terms: D000200:Action Potentials / Q000502:physiology; D000293:Adolescent; D002648:Child; D003929:Diabetic Neuropathies / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D004558:Electric Stimulation; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D008297:Male; D008475:Median Nerve / Q000503:physiopathology; D009431:Neural Conduction / Q000502:physiology*; D009460:Neurologic Examination / Q000379:methods*; D015995:Prevalence; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index
chemical_list: D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human