Youth with diabetes at risk for diabetic peripheral neuropathy

Jaiswal M. Diabetes Care. 2013;doi:10.2337/dc13-1213.

  • November 1, 2013

The prevalence of diabetic peripheral neuropathy was 8.2% among youth with type 1 diabetes and 25.7% among those with type 2 diabetes, according to data reported by the SEARCH for Diabetes in Youth study group.

Young patients with diabetic peripheral neuropathy were also more likely to have type 2 diabetes and an adverse cardiovascular risk profile (ie, central obesity, higher blood pressure, lower HDL cholesterol and microalbuminuria), according to Mamta Jaiswal, MBBS, PhD, of the department of neurology at the University of Michigan in Ann Arbor, and colleagues.

“Our pilot study found evidence that the prevalence of [diabetic peripheral neuropathy] in adolescents with type 2 diabetes approaches rates reported in adults with diabetes,” Jaiswal and colleagues wrote. “Awareness and periodic assessment of this complication in its early subclinical stage might prevent the poor quality of life associated with [diabetic peripheral neuropathy] in the future by allowing early application of suitable interventions.”

Researchers used the Michigan Neuropathy Screening Instrument (MNSI) as an examination for foot abnormalities, distal vibration perception and ankle reflexes, according to data.

The examination was completed on 399 patients, including 329 youth with type 1 diabetes (mean age, 15.7 years; duration of 6.2 years) and 70 patients with type 2 diabetes (mean age, 21.6 years; duration, 7.6 years). Data indicate HbA1c levels were similar in both groups (8.8% for type 1 diabetes vs. 8.5% for type 2 diabetes).

The prevalence of diabetic peripheral neuropathy was also significantly higher among youth with type 2 diabetes compared with patients with type 1 diabetes (25.7% vs. 8.2%; P<.0001), according to data.

Further analyses determined that the type of diabetes, older age, longer duration of diabetes, increased waist circumference, elevated BP, lower HDL cholesterol and presence of microalbuminuria were associated with diabetic peripheral neuropathy, researchers wrote.

These associations remained significant after adjustments for age and sex (OR=2.29; 95% CI, 1.05-5.02), according to data.

Disclosure: The researchers report no relevant financial disclosures.

Perspective
Tamara L. Wexler, MD, PhD

Tamara L. Wexler

  • The negative effects of diabetes are often felt via sequelae, including the diabetic peripheral neuropathy this article addresses. Whereas prior studies have focused on the effects of diabetes in adults, the changing face of the disease forces us to anticipate the health impact on children and adolescents. This timely article brings our attention to the need to assess diabetic sequelae —  neuropathy in this case — in children with diabetes.

    The article separates its cohort into patients with type 1 diabetes (n=320) and, in comparison, patients with type 2 diabetes (n=70), and initially mentions that children with type 2 diabetes demonstrate higher rates of diabetic neuropathy; those children were older and had longer durations of diagnosed diabetes. Of note, however, the significance of any relative difference in diabetic neuropathy between both groups disappeared once co-variants were taken into account. It thus appears that the risk for diabetic peripheral neuropathy is more closely related to duration of exposure to hyperglycemia or to other risk factors (ie, cardiometabolic risk factors mentioned in the article). Moreover, independent predictors noted were similar to those found in adult patients.

    Regular screening for sequelae should be performed in all patients with diabetes, regardless of diabetes type or patient age; the long-term negative effects on quality-of-life, overall health, and costs cannot be considered problems solely for adults.

    • Tamara L. Wexler, MD, PhD
    • Neuroendocrinologist
      Attending physician in the department of medicine
      Massachusetts General Hospital
  • Disclosures: Wexler reports no relevant financial disclosures.

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