Subclinical neuropathy in type I diabetic children

Small and large, somatic and autonomic nerve fibre functions were neurophysiologically evaluated in 33 asymptomatic neurologically free type I diabetic children and 69 age-matched healthy controls.

The evaluation of large and small somatic nerve fibre function was performed by conventional nerve conduction studies, thermal specific and thermal pain sensitivity tests, as well as autonomic nerve fibre functions by sympathetic skin response and R-R interval variation assessment.

A significant difference was established between the healthy and the diabetic group. Neurophysiologically determined subclinical neuropathy was found in 87% of type I diabetic children. The majority of abnormal recordings were found on the lower limbs. The dysfunction of the somatic motor large nerve fibre type in the lower limbs was altered in 57% of patients, somatic sensory large in 39%, somatic sensory small in 45%, and sympathetic in 45%. The leading abnormal measure was a delayed sympathetic skin response on the foot (42% of diabetic children) followed by a reduced amplitude of sural nerve action potential (36%). The whole spectrum of recordings showed scattered involvement of nerve functions. There was no selective susceptibility of nerve fibre types exposed to a noxious factor.

A complex neurophysiological assessment, including standard nerve conduction studies as well as psychophysical examination and autonomic nerve function tests, evaluating the function of small and large nerve fibres, is recommended for evaluating the subclinical neuropathy in asymptomatic type I diabetic children.