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Childhood diabetic neuropathy: functional impairment and non-invasive screening assessment

M Blankenburg1, N Kraemer, G Hirschfeld

  • 1Vodafone 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

Diabetic Medicine : a Journal of the British Diabetic Association
|April 18, 2012
PubMed

Insights

Diabetic neuropathy is common in children with Type 1 diabetes, affecting nearly half. Tactile sensation testing is a sensitive and specific screening tool for detecting this nerve dysfunction.

Area of Science:

  • Pediatric Endocrinology
  • Neurology
  • Diabetology

Background:

  • Sensory diabetic neuropathy is prevalent in children with Type 1 diabetes but often asymptomatic.
  • Diagnosing diabetic neuropathy in pediatric care is challenging due to lack of symptoms and impracticality of nerve conduction studies.
  • Subclinical large- and small-fiber neuropathies affect a significant portion of children with diabetes.

Purpose of the Study:

  • To describe somatosensory dysfunction in children with Type 1 diabetes.
  • To investigate the relationship between diabetes duration, HbA1c, and somatosensory dysfunction.
  • To identify the most effective screening test for large-fiber dysfunction.

Main Methods:

  • Assessment of 45 children with Type 1 diabetes and matched controls using neurological exams, nerve conduction tests, and quantitative sensory testing on the feet.
  • Nerve conduction tests served as the gold standard for defining neuropathy.
  • Utilized the German Research Network on Neuropathic Pain protocol for quantitative sensory testing.

Main Results:

  • A high prevalence of mechanical (38%) and thermal (24%) hypoesthesia was observed, often with hyperalgesia (47%).
  • Tactile hypoesthesia (33%) was more common than vibration detection deficits (11%).
  • Tactile hypoesthesia demonstrated high sensitivity (75%) and specificity (89%) for detecting neuropathy.

Conclusions:

  • Nearly half of children with diabetes exhibit subclinical large- and small-fiber neuropathies.
  • Tactile sensation testing is a more effective screening tool for neuropathy than vibration detection.
  • Quantitative sensory testing is valuable for assessing neuropathy and guiding interventions in pediatric diabetes.
Abstract

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