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Prevalence and Presentation of Lower Limb Neurovascular Complications in Children With Diabetes: A Systematic Review
Iris Syifaa Fathiah Irwandy1, Fiona Hawke1, Andrea Coda1,2
1School of Health Sciences, College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, NSW, Australia.
Insights
Diabetic lower limb complications like neuropathy and vasculopathy can occur in children, with prevalence varying widely due to assessment methods. Early detection is crucial for this population.
Area of Science:
- Pediatrics
- Endocrinology
- Diabetology
Background:
- Lower limb complications are common in diabetic individuals, potentially leading to severe long-term issues.
- Current evidence on these complications in children with diabetes is limited, relying on infrequent or uncomfortable assessments.
- Clinical guidelines lack specific recommendations for the frequency of neurovascular assessments in pediatric diabetes patients.
Purpose of the Study:
- To systematically review the prevalence and clinical presentation of neuropathy and vasculopathy in children with diabetes.
- To synthesize existing evidence on lower limb complications in pediatric diabetes populations.
- To identify gaps in current research and clinical guidelines.
Main Methods:
- A systematic literature search was performed across EMBASE, Cochrane, PubMed, and CINAHL in March 2024.
- Studies were independently screened and assessed for quality using the Downs and Black checklist by at least two authors.
- Data extraction, summarization, tabulation, and meta-analysis were conducted.
Main Results:
- Eighteen studies involving 3533 participants (aged 3.5-18 years; 95% Type 1 diabetes) were included.
- Prevalence of clinical neuropathy ranged from 0% to 57.1%, and vascular complications from 0% to 37.8%.
- Meta-analysis indicated 0%-7% of children reported abnormalities in neuropathy assessments; however, significant heterogeneity was noted.
Conclusions:
- The wide range in prevalence suggests methodological heterogeneity and potential reporting inadequacies in existing studies.
- Emerging evidence indicates that diabetic complications can manifest in children before age 18, necessitating clinical vigilance.
- Higher quality, longitudinal studies are essential to inform clinical screening protocols for lower limb vascular and neurological complications in pediatric patients.
Abstract:
Introduction: Disorders of the lower limb are common in people with diabetes and may result in significant long-term complications. Currently, most evidence for lower limb complications in children with diabetes relies on infrequent clinical observations and occasionally invasive assessments that can cause discomfort. Clinical guidelines do not provide explicit guidance on frequency of neurovascular assessments for children with diabetes. Aim: To systematically review the prevalence and presentation of clinical neuropathy and vasculopathy in children with diabetes. Methods: A systematic search of the literature was conducted in March 2024 using the EMBASE, Cochrane, PubMed (including MEDLINE) and CINAHL databases. At least two authors independently screened studies for inclusion and assessed methodological quality for each paper using the downs and black quality appraisal checklist. Extracted data was summarised and tabulated. Meta-analysis was also performed. Results: Eighteen studies with 3533 participants were included. Participants were aged 3.5-18 years, and 95% had type 1 diabetes, while 5% had type 2 diabetes. These studies used a range of assessments, including monofilament, vibrioception, sharp-blunt discrimination, temperature perception, reflexes, muscle strength and tone, joint perception, pedal pulses, and ankle brachial index (ABI). Prevalence of clinical neuropathy ranged from 0% to 57.1% with a prospective cohort study reporting a 2.6-fold increase in 5 years, while prevalence of vascular complications ranged from 0% to 37.8%. The meta-analysis reported 0%-7% of children could report abnormality on assessments for neuropathy. Conclusion: The broad range may be due to heterogeneous methodological designs and diagnostic assessments, and potentially inadequate reporting. There is emerging evidence that children with diabetes may develop complications before age 18, which provides impetus for clinical caution. Higher quality evidence, particularly from longitudinal studies, is required to guide clinical screening for lower limb vascular and neurological complications in this vulnerable and growing paediatric population.
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