Peripheral Nerve Function Is Increasingly Impaired During Puberty in Adolescents With Type 1 Diabetes

Abstract

OBJECTIVE -To evaluate the impact of puberty on peripheral nerve function in adolescents with type 1 diabetes.RESEARCH DESIGN AND METHODS -Of 138 eligible patients with type 1 diabetes, 100 patients (age Ͼ9 years and diabetes duration Ͼ2 years) attending an outpatient diabetes clinic and 100 age-and sex-matched healthy control subjects took part in this cross-sectional study. Peripheral motor and sensory nerve conduction tests, cardiovascular reflex tests on the autonomic nervous system, and measurements of vibration-perception threshold (VPT) were performed.RESULTS -Nerve conduction velocity (NCV) in the distal motor and sensory nerves, the motor nerve distal latency, and the sensory nerve action potential (SNAP) amplitude were impaired in the adolescent patients with type 1 diabetes. The deterioration in motor NCV, H-reflex latency, and SNAP amplitude became more conspicuous in late puberty and postpuberty and was related to poor metabolic control. A total of 10 patients had distal diabetic polyneuropathy (DP) neurophysiologically, and these patients had significantly lower heart-rate variation in the deep breathing test than the other patients. Three of the patients with DP had peripheral neurological signs or symptoms. A slight difference in the VPT between the patients and control subjects was observed after puberty.CONCLUSIONS -Increasing subclinical motor nerve impairment can be detected during late puberty and after puberty, and sensory NCV and SNAP amplitude are reduced in adolescents with type 1 diabetes. Poor metabolic control during puberty appears to induce deteriorating peripheral neural function in young patients with type 1 diabetes.

Validity of the Neurological Examination in Diagnosing Diabetic Peripheral Neuropathy

“…In addition, only a few studies have been performed on NCV in diabetic children, and the reported prevalence of DPN varies greatly among different studies (Table 1) [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25].…”

Early Diabetes-Related Complications in Adolescents

“…Nonetheless, numerous studies provide evidence of abnormalities in both peripheral and autonomic nerve function in children and teens with type 1 diabetes [61,62,63,64,65]. Once again, older age, longer duration of diabetes and poorer metabolic control appear to be contributing factors to nerve dysfunction [61, 62]. …”

“…Riihimaa et al [61] reported increasing subclinical motor nerve impairment during late puberty and after puberty, and reduced sensory nerve conduction velocity and sensory nerve action potentials in adolescents with type 1 diabetes. Similarly, Abad et al [62] found that symptomatic abnormal cutaneous thermal perception is a common finding in young patients with type 1 diabetes.…”

“…(2) In people with type 2 diabetes, screening and evaluation for retinopathy by an experienced professional should be performed at the time of diagnosis [61]. The interval for follow-up assessments should be tailored to the severity of the retinopathy.…”

Neurophysiological evaluation in newly diagnosed Diabetes Mellitus type 1

“…Recently, the possibility to verifying neuropathic alterations at the time of diabetes mellitus diagnosis, particularly diabetes mellitus type 1 (DM type1) was presented in different studies [1,2]. Previous reports pointed out that acute effects of normalization of blood glucose levels and other metabolic parameters have a direct influence on nerve conduction velocity (NCV), as well as on the nerve structure itself [3]. Hyperglycemia is a significant, but also not the crucial factor, that can lead to blood vessel damage (primarily of capillaries) and hence to the decrease of blood flow in the nerve tissue itself.…”