Sophausvaporn Piengjai, Boonhong Jariya, Sahakitrungruang Taninee
Division of Endocrinology, Department of Pediatrics, Chulalongkorn University, and King Chulalongkorn Memorial Hospital, Thai Red Cross Societ y, Bangkok, Thailand.
Department of Rehabilitation Medicine, Faculty of Medicine, Chulalongkorn University, and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.
Ann Pediatr Endocrinol Metab. 2023 Mar;28(1):20-25. doi: 10.6065/apem.2244092.046. Epub 2023 Feb 1.
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 to assess the sensitivity and specificity of monofilament testing and noninvasive screening to diagnose DN compared with the gold standard nerve conduction study (NCS).
Sixty-five Thai children and adolescents (39 females) diagnosed with diabetes before 15 years of age were included. All subjects were screened for DN by foot and neurological examinations, light touch sensation by 10 g Semmes-Weinstein monofilaments, and the Michigan Neuropathy Screening Instrument (MNSI). NCSs were used as the gold standard for diagnosis of DN.
Fifty-eight patients had type 1 diabetes ( T1D), 5 patients had type 2 diabetes, and 2 patients had other types of diabetes. The mean age was 17.7±4.6 years (8-33 years). The prevalence of DN in this cohort was 12.3% by NCS. All subjects were asymptomatic. Mean diabetes duration did not differ between the groups (with DN 8.0±3.0 years vs. no DN 8.2±5.0 years). Notably, one patient with T1D developed DN within 3 years after diagnosis. Poor glycemic control was a significant risk factor for DN. Glycosylated hemoglobin was higher in the 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, 4.97; 95% confidence interval, 1.5-16.46). Foot and neurological examinations, monofilaments, and the MNSI failed to detect DN in all subjects with abnormal NCS.
The prevalence of DN in pediatric-onset diabetes is not uncommon but mainly is subclinical. Poor glycemic control is the main risk factor. Noninvasive screening tests for DN exhibited poor diagnostic sensitivity in the pediatric population.
糖尿病性神经病变（DN）是糖尿病的一种严重并发症。我们旨在确定一家三级医疗中心儿童期发病糖尿病患者中DN的患病率，并评估与金标准神经传导研究（NCS）相比，单丝试验和无创筛查诊断DN的敏感性和特异性。
纳入65例15岁之前被诊断为糖尿病的泰国儿童和青少年（39例女性）。所有受试者均通过足部和神经系统检查、用10g Semmes-Weinstein单丝检测轻触觉以及密歇根神经病变筛查工具（MNSI）进行DN筛查。NCS被用作诊断DN的金标准。
58例患者为1型糖尿病（T1D），5例为2型糖尿病，2例为其他类型糖尿病。平均年龄为17.7±4.6岁（8 - 33岁）。根据NCS，该队列中DN的患病率为12.3%。所有受试者均无症状。两组间平均糖尿病病程无差异（有DN组为8.0±3.0年，无DN组为8.2±5.0年）。值得注意的是，1例T1D患者在诊断后3年内发生了DN。血糖控制不佳是DN的一个显著危险因素。DN组糖化血红蛋白更高（10.6%±2.3%对8.5%±1.6%，P = 0.008）。糖尿病肾病的发生与DN相关（患病率比值比，4.97；95%置信区间，1.5 - 16.46）。足部和神经系统检查、单丝试验以及MNSI未能在所有NCS异常的受试者中检测出DN。
儿童期发病糖尿病患者中DN的患病率并不罕见，但主要为亚临床状态。血糖控制不佳是主要危险因素。DN的无创筛查试验在儿童人群中诊断敏感性较差。
