US researchers call for clinical guidelines for detection of diabetic peripheral neuropathy (DPN) in children after finding that a significant proportion of young patients are affected.
"A screening test with the best sensitivity and specificity must be identified," say Joanne Moser (The Children's Hospital of Philadelphia, Pennsylvania) and co-authors. "Further research of asymptomatic high risk youth is also critical."
The team reports that 26% of 151 children with Type 1 diabetes, aged 8 to 21 years, had a positive screening test for DPN.
This included six (75%) of eight patients at high-risk for DPN - defined as age 13 years or older, diabetes duration of at least 5 years, and a glycated hemoglobin (HbA1c) level of 10% or higher on two of the previous four measurements.
But 33 (23%) of the 143 patients who did not meet these risk criteria also had a positive screening test for DPN, which included a modified version of the Michigan Neuropathy Screening Inventory, a foot inspection, ankle reflex testing, monofilament (10 g) examination, and tuning fork testing.
Follow-up with a pediatric neurologist confirmed DPN in five (62.5%) of the high-risk and 11 (46.0%) of the low-risk patients.
The average age of patients with confirmed DPN was 16.2 years. Although the average HbA1c was 8.7%, seven patients had a level equal to or below 8%. Average duration of diabetes in the DPN group was 6.4 years, but two patients had been diagnosed with diabetes within the past year.
Indeed, there was no significant correlation between diagnosis of DPN and patient age, duration of diabetes, HbA1c or cholesterol level, or height at puberty, although the researchers say this may be due to sample size or the cross-sectional study design.
"This study highlights that DPN can occur in youth at any age and at any time from the onset of diagnosis," Moser et al write in Diabetes Research and Clinical Practice.
"These data raise our awareness of DPN in youth and challenge us to incorporate routine screening in practice as supported by research done outside of the US."
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