Prevalence of Peripheral Neuropathy in Children and Adolescents With Type I Diabetes Mellitus: a Prospective Study
Condition: Diabetes Mellitus Type I; Diabetic Peripheral Neuropathy; Nerve Conduction Study Not Performed
MeSH terms: Peripheral Nervous System Diseases; Diabetes Mellitus; Diabetes Mellitus, Type 1
Study type: Observational

Summary: 
      Diabetes mellitus type I is an increasing burden for more and younger children. Therapy
      should avoid long-term complications as macrovascular diseases and diabetic nephropathy,
      retinopathy and diabetic neuropathy (DN). There is considerable uncertainty about the
      prevalence of DN due to a lack of large epidemiological studies and consensus on diagnostic
      criteria. Nerve conduction velocity studies are regarded as the "gold standard" for
      investigating neuropathies.

      We plan a prospective study by investigating the peripheral nerve conduction velocity in a
      population of diabetic children. At the same time-points, we will do a neurological
      examination using the Young Score, a clinical score of peripheral neuropathy [10]. The
      results obtained will be related to other long-term vascular complications (nephropathy,
      retinopathy), glycaemic control, duration of diabetes, insulin dose regime, hours of
      sports/week, and BMI
    

Detailed description: 
      The number of newly diagnosed patients with diabetes mellitus type I increases every year,
      with the patients becoming younger. The Austrian Diabetes Incidence Study Group demonstrated
      a significant and constant increase in the incidence rate from 12.0 to 18.4/100,000 in
      children and adolescents ≤15 years of age from 1999 to 2007 [7]. So, we are confronted with
      more and more children and adolescents suffering from complications which determine long-term
      outcome. Chronic disease and complications have an important impact on quality and
      expectation of life and on health resources.

      Among the long-term complications of diabetes, vascular complications including retinopathy,
      nephropathy, neuropathy, and macrovascular disease are the most prevalent [2]. The main
      therapeutic goal is to avoid these complications by early detection of clinical or, even
      better, subclinical signs. For this reason, the International Society for Pediatric and
      Adolescent Diabetes (ISPAD) periodically issues Clinical Practice Consensus Guidelines,
      particularly for screening for vascular complications [2]. With regard to diabetic neuropathy
      (DN) there is still uncertainty about the time frame, intensity and diagnostic method of
      choice, despite it is a significant source of morbidity and mortality [3]. Additionally,
      there is considerable uncertainty about the prevalence of DN due to a lack of large
      epidemiological studies and consensus on diagnostic criteria [4].

      The American Academy of Neurology suggests a combination of objective and symptoms, signs and
      electrophysiology provides the most accurate diagnosis of distal symmetric polyneuropathy
      [5]. Nerve conduction studies are considered by many as the "gold standard" for nerve damage
      and the most consistent indicator of (sub-)clinical neuropathy [6].

      So far, several cross-sectional studies have been conducted on nerve conduction velocity in
      diabetic children. The results in regard of prevalence are largely divergent. We found that
      15 out of 39 patients (38.5%) had a pathological nerve conduction velocity. This result
      neither correlated to a clinical symptom score (Young Score which consist of a Neurological
      Deficiency Score, NDS and a Neuropathy Symptom Score, NSS) [10], nor to mean HbA1c, patients
      age, duration of diabetes, body mass index, insulin regime, hours of sports or metabolic
      testing results.

      Only one long-term prospective study addressing the issue of the development of diabetic
      neuropathy in a juvenile population was done so far [8]. To better understand the long term
      development of diabetic neuropathy we plan to study the peripheral nerve conduction velocity
      in a population of diabetic children from our outpatient clinic. At the same time, we will do
      a neurological examination using the Young Score, a clinical score of peripheral neuropathy
      [10].

      The results obtained will be related to other long-term vascular complications (nephropathy,
      retinopathy), glycaemic control, duration of diabetes, insulin dose regime, hours of
      sports/week, and BMI
    

Observational model: Cohort
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Children and adolescents 8 to 18 years suffering from diabetes mellitus type I for more
        than one year.