Department of Neurology, University of Michigan Medicine, Ann Arbor, Michigan, USA.
Pediatr Diabetes. 2021 Mar;22(2):132-147. doi: 10.1111/pedi.13153. Epub 2020 Nov 24.
Pediatric neuropathy attributed to metabolic dysfunction is a well-known complication in children and youth with type 1 diabetes. Moreover, the rise of obesity and in particular of type 2 diabetes may cause an uptick in pediatric neuropathy incidence. However, despite the anticipated increase in neuropathy incidence, pathogenic insights and strategies to prevent or manage neuropathy in the setting of diabetes and obesity in children and youth remain unknown. Data from adult studies and available youth cohort studies are providing an initial understanding of potential diagnostic, management, and preventative measures in early life. This review discusses the current state of knowledge emanating from these efforts, with particular emphasis on the prevalence, clinical presentation, diagnostic approaches and considerations, and risk factors of neuropathy in type 1 and type 2 diabetes in children and youth. Also highlighted are current management strategies and recommendations for neuropathy in children and youth with diabetes. This knowledge, along with continued and sustained emphasis on identifying and eliminating modifiable risk factors, completing randomized controlled trials to assess effectiveness of strategies like weight loss and exercise, and enhancing awareness to support early detection and prevention, are pertinent to addressing the rising incidence of neuropathy associated with diabetes and obesity in children and youth.
小儿代谢功能障碍性神经病是儿童和青少年 1 型糖尿病的一种常见并发症。此外，肥胖症的上升，特别是 2 型糖尿病的上升，可能导致小儿神经病发病率上升。然而，尽管预计神经病的发病率会上升，但在儿童和青少年中，糖尿病和肥胖症背景下的神经病发病机制和预防或管理策略仍不清楚。来自成人研究和现有青年队列研究的数据为早期生活中的潜在诊断、管理和预防措施提供了初步认识。这篇综述讨论了这些努力所产生的现有知识状况，特别强调了儿童和青少年 1 型和 2 型糖尿病神经病的患病率、临床表现、诊断方法和考虑因素以及危险因素。还强调了目前针对糖尿病儿童和青少年神经病的管理策略和建议。这些知识，以及继续和持续强调确定和消除可改变的危险因素、完成评估减肥和运动等策略有效性的随机对照试验，以及提高认识以支持早期发现和预防，对于解决与儿童和青少年糖尿病和肥胖症相关的神经病发病率上升问题至关重要。
