Key result
Type 1 diabetes in adolescents was associated with a 14% prevalence of confirmed large fiber neuropathy, while bedside diagnostic tests showed poor to acceptable concordance (AUC ≤ 0.75).
Why the study?
To estimate the prevalence of large fiber, small fiber, and autonomic neuropathy in adolescents with type 1 diabetes using adult confirmatory tests, and to identify risk factors and bedside methods.
What is the prevalence of neuropathy in adolescents with type 1 diabetes, and how do bedside diagnostic tests compare to confirmatory tests?
Cross-Sectional (n=83)
What is the prevalence of neuropathy in adolescents with type 1 diabetes, and how do bedside diagnostic tests compare to confirmatory tests?
Confirmatory diagnostic tests reveal a notable prevalence of neuropathy in adolescents with type 1 diabetes, while bedside tests show limited diagnostic concordance.
Adult confirmatory tests detect neuropathy in long-duration pediatric T1D; leaves open validation of thresholds and bedside utility in youth.
AIMS: To estimate the prevalence of large fiber (LFN), small fiber (SFN), and autonomic neuropathy in adolescents with type 1 diabetes using confirmatory tests known from adults and to identify risk factors and bedside methods for neuropathy. METHODS: Sixty adolescents with type 1 diabetes (diabetes duration > five years) and 23 control subjects underwent neurological examination and confirmatory diagnostic tests for neuropathy, including nerve conduction studies, skin biopsies determining intraepidermal nerve fiber density, quantitative sudomotor axon reflex test (QSART), cardiovascular reflex tests (CARTs), and tilt table test. Possible risk factors were analyzed. Bedside tests (biothesiometry, DPNCheck®, Sudoscan, and Vagus®device) were compared with the confirmatory tests using ROC analysis. RESULTS: The prevalence of neuropathies in the adolescents with diabetes (mean HbA1c 7.6% (60 mmol/mol)) was as follows: 14% confirmed/26% subclinical LFN, 2% confirmed/25% subclinical SFN, 20% abnormal QSART, 8% abnormal CARTs, and 14% orthostatic hypotension. Higher age, higher insulin dose, previous smoking, and higher triglycerides level were found to increase the relative risk for neuropathy. The bedside tests showed poor to acceptable concordance with the confirmatory tests (all, AUC ≤ 0.75). CONCLUSIONS: The diagnostic tests confirmed the presence of neuropathy in adolescents with diabetes and underscore the importance of prevention and screening.
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Rasmussen et al. (2023) conducted a cross-sectional in Type 1 diabetes (n=83). Type 1 diabetes vs. Control subjects was evaluated on Prevalence of large fiber, small fiber, and autonomic neuropathy, and concordance of bedside tests. Type 1 diabetes in adolescents was associated with a 14% prevalence of confirmed large fiber neuropathy, while bedside diagnostic tests showed poor to acceptable concordance (AUC ≤ 0.75).
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