Tinti Davide, Canavese Carlotta, Nobili Cecilia, Marcotulli Daniele, Daniele Erika, Rabbone Ivana, de Sanctis Luisa
Department of Pediatrics, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy.
Child and Adolescent Neuropsychiatry Unit, Department of Sciences of Public Health and Pediatrics, University of Turin, Turin, Italy.
Front Med (Lausanne). 2024 May 9;11:1331145. doi: 10.3389/fmed.2024.1331145. eCollection 2024.
Diabetic neuropathy (DN) is one of the most insidious microvascular complications in patients with type 1 diabetes (T1DM) and initial signs may appear during childhood. The aim of this study is to evaluate associations between the Nerve Conduction Studies (NCS) outcomes at enrollment with neuropathy screening questionnaires performed six years later in a cohort of asymptomatic adolescents followed up until early adulthood, affected by T1DM.
We performed NCS in a cohort of seventy-two adolescents with T1DM and eighteen healthy controls. Six years later, screening questionnaires for DN were proposed: Michigan Neuropathy Screening Instrument (MNSI, specific for symptoms of somatic dysfunction), Composite Autonomic Symptom Score 31 (COMPASS 31, specific for abnormalities of the autonomic component) and Clarke questionnaire (perception of hypoglycemia). Thirty-two TD1M subjects agreed to participate in the follow-up; main clinical-metabolic parameters, including the number of episodes of hypoglycemia in the past twelve months, were collected.
11.8% of subjects showed changes compatible with DN through the MNSI questionnaire, while 41% declared a reduced perception of hypoglycemia on the Clarke questionnaire. No significant correlation was observed between the clinical-metabolic parameters or altered response to NCS and scores of MNSI and COMPASS 31 questionnaires. On the other hand, an association was observed between NCS abnormalities and a high number of hypoglycemic events after six years (97-fold increased risk, = 0.009).
The frequency of somatic alterations in the study population is 11.8%, whereas the frequency of symptoms correlated with autonomic damage is about 41%. An autonomic impairment recorded at NCS may represent a six-year risk factor for increased hypoglycemic episodes, even if more extensive studies are needed to investigate this possible relationship further.
糖尿病神经病变（DN）是1型糖尿病（T1DM）患者最隐匿的微血管并发症之一，早期症状可能在儿童期出现。本研究旨在评估一组无症状青少年T1DM患者在入组时的神经传导研究（NCS）结果与六年后进行的神经病变筛查问卷之间的关联，这些患者随访至成年早期。
我们对72名T1DM青少年和18名健康对照者进行了NCS。六年后，提出了DN筛查问卷：密歇根神经病变筛查工具（MNSI，针对躯体功能障碍症状）、自主神经症状综合评分31（COMPASS 31，针对自主神经成分异常）和克拉克问卷（低血糖感知）。32名T1DM受试者同意参与随访；收集了主要临床代谢参数，包括过去12个月的低血糖发作次数。
通过MNSI问卷，11.8%的受试者显示出与DN相符的变化，而41%的受试者在克拉克问卷上表示低血糖感知降低。临床代谢参数或NCS反应改变与MNSI和COMPASS 31问卷得分之间未观察到显著相关性。另一方面，观察到NCS异常与六年后大量低血糖事件之间存在关联（风险增加97倍，P = 0.009）。
研究人群中躯体改变的发生率为11.8%，而与自主神经损伤相关的症状发生率约为41%。NCS记录的自主神经损伤可能是低血糖发作增加的六年风险因素，尽管需要更广泛的研究来进一步调查这种可能的关系。
