Irwandy Iris Syifaa Fathiah, Hawke Fiona, Coda Andrea, McGee Richard G, Birt Stewart, Fellas Antoni
School of Health Sciences, College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, NSW, Australia.
Equity in Health and Wellbeing Research Program, Hunter Medical Research Institute (HMRI), Newcastle, NSW, Australia.
Pediatr Diabetes. 2025 Jun 23;2025:7664860. doi: 10.1155/pedi/7664860. eCollection 2025.
Disorders of the lower limb are common in people with diabetes and may result in significant long-term complications. Currently, most evidence for lower limb complications in children with diabetes relies on infrequent clinical observations and occasionally invasive assessments that can cause discomfort. Clinical guidelines do not provide explicit guidance on frequency of neurovascular assessments for children with diabetes. To systematically review the prevalence and presentation of clinical neuropathy and vasculopathy in children with diabetes. A systematic search of the literature was conducted in March 2024 using the EMBASE, Cochrane, PubMed (including MEDLINE) and CINAHL databases. At least two authors independently screened studies for inclusion and assessed methodological quality for each paper using the downs and black quality appraisal checklist. Extracted data was summarised and tabulated. Meta-analysis was also performed. Eighteen studies with 3533 participants were included. Participants were aged 3.5-18 years, and 95% had type 1 diabetes, while 5% had type 2 diabetes. These studies used a range of assessments, including monofilament, vibrioception, sharp-blunt discrimination, temperature perception, reflexes, muscle strength and tone, joint perception, pedal pulses, and ankle brachial index (ABI). Prevalence of clinical neuropathy ranged from 0% to 57.1% with a prospective cohort study reporting a 2.6-fold increase in 5 years, while prevalence of vascular complications ranged from 0% to 37.8%. The meta-analysis reported 0%-7% of children could report abnormality on assessments for neuropathy. The broad range may be due to heterogeneous methodological designs and diagnostic assessments, and potentially inadequate reporting. There is emerging evidence that children with diabetes may develop complications before age 18, which provides impetus for clinical caution. Higher quality evidence, particularly from longitudinal studies, is required to guide clinical screening for lower limb vascular and neurological complications in this vulnerable and growing paediatric population.
下肢疾病在糖尿病患者中很常见，可能会导致严重的长期并发症。目前，关于糖尿病儿童下肢并发症的大多数证据依赖于不频繁的临床观察以及偶尔进行的可能会引起不适的侵入性评估。临床指南并未针对糖尿病儿童神经血管评估的频率提供明确指导。为了系统地回顾糖尿病儿童临床神经病变和血管病变的患病率及表现。2024年3月，利用EMBASE、Cochrane、PubMed（包括MEDLINE）和CINAHL数据库对文献进行了系统检索。至少两名作者独立筛选纳入研究，并使用唐斯和布莱克质量评估清单对每篇论文的方法学质量进行评估。对提取的数据进行了总结和列表。还进行了荟萃分析。纳入了18项研究，共3533名参与者。参与者年龄在3.5至18岁之间，95%患有1型糖尿病，5%患有2型糖尿病。这些研究采用了一系列评估方法，包括单丝检查、振动觉、锐钝辨别、温度觉、反射、肌肉力量和张力、关节觉、足背动脉搏动以及踝臂指数（ABI）。临床神经病变的患病率在0%至57.1%之间，一项前瞻性队列研究报告称5年内患病率增加了2.6倍，而血管并发症的患病率在0%至37.8%之间。荟萃分析报告称，0%至7%的儿童在神经病变评估中可能报告异常。差异范围较大可能是由于方法学设计和诊断评估的异质性，以及潜在的报告不足。有新证据表明，糖尿病儿童可能在18岁之前就出现并发症，这为临床谨慎提供了依据。需要更高质量的证据，尤其是来自纵向研究的证据，以指导对这一脆弱且不断增长的儿科人群进行下肢血管和神经并发症的临床筛查。
