The prevalence of diabetic peripheral neuropathy in youth with diabetes mellitus.

BACKGROUNDS: Diabetic neuropathy (DN) is a serious complication in diabetes mellitus. We aimed to determine the prevalence of DN in pediatric-onset diabetes in a tertiary care center and assess the sensitivity and specificity of monofilament test and non-invasive screening to diagnose DN compared with the gold standard nerve conduction studies (NCS).

METHODS: Sixty-five Thai children and adolescents (39 females), diagnosed with diabetes before 15 years old were included. All subjects were screened for DN by foot and neurological examination, light touch sensation by 10 g Semmes-Weinstein monofilaments, and Michigan Neuropathy Screening Instrument. NCS were used as a gold standard for diagnosis of DN.

RESULTS: 58 patients had type 1 diabetes (T1D), 5 patients had type 2 diabetes, and 2 patients had other types. Mean age was 17.7±4.6 y (8-33 y). The prevalence of DN in this cohort was 12.3% by NCS. All subjects were asymptomatic. Mean diabetes duration was not different between groups (with DN 8.0±3.0 vs. no DN 8.2±5.0 years). Notably, one patient with T1D developed DN within 3 years after diagnosis. Poor glycemic control was the significant risk factor for DN. HbA1c was higher in DN group (10.6±2.3% vs. 8.5±1.6%, P=0.008). The occurrence of diabetic nephropathy was associated with DN [prevalence rate ratio (95% CI), 4.97 (1.5, 16.46)]. Foot and neurological examination, monofilaments and Michigan Neuropathy Screening Instrument failed to detect DN in all subjects with abnormal NCS.

CONCLUSION: The prevalence of diabetic neuropathy in pediatric-onset diabetes is not uncommon, but mainly subclinical. Poor glycemic control is the main risk factor. Non-invasive screening test for DN had poor diagnostic sensitivity in pediatric population.