Prevalence of Peripheral Neuropathy in Children and Adolescents With Type I Diabetes Mellitus: a Prospective Study

Study Description

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Brief 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

Condition or disease
Diabetes Mellitus Type I; Diabetic Peripheral Neuropathy; Nerve Conduction Study Not Performed

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

Study Design

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Study Type :	Observational
Actual Enrollment :	35 participants
Observational Model:	Cohort
Time Perspective:	Prospective
Official Title:	Prospective Study of Peripherla Neuropathy in Diabetic Type I
Study Start Date :	December 2011
Actual Primary Completion Date :	December 2015
Actual Study Completion Date :	December 2015

Groups and Cohorts

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Outcome Measures

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Study Description Study Design Groups and Cohorts Outcome Measures Eligibility Criteria Contacts and Locations More Information

Primary Outcome Measures :

1. What is the long term development of diabetic neuropathy? Is there a significant deterioration or improvement in nerve conduction during the follow up period? [ Time Frame: 5-years ]

Secondary Outcome Measures :

1. Correlation to mean HbA1c [ Time Frame: 5 years ]
2. mean BMI [ Time Frame: 5 years ]
3. Blood pressure [ Time Frame: 5 years ]
4. Retinopathy [ Time Frame: 5 years ]
5. Nephropathy [ Time Frame: 5 years ]

Eligibility Criteria

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Study Description Study Design Groups and Cohorts Outcome Measures Eligibility Criteria Contacts and Locations More Information

Ages Eligible for Study:	8 Years to 18 Years (Child, Adult)
Sexes Eligible for Study:	All
Accepts Healthy Volunteers:	No
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.

Criteria

Inclusion Criteria:

• 8 to 18 years suffering from diabetes mellitus type I for more than one year.

Exclusion Criteria:

• Children who are unable to understand informed consent
• Diabetic children with duration of diabetes < 1 year, age <8 or >18
• Insulin < 0.5IE/kg/d
• Blood glucose before examination below 50 or above 350mg/dL
• Children with chronic diseases, handicapped children, children with cancer, chronic renal impairment, or neurological diseases
• Children who are on medications that can produce peripheral neuropathy, i.e antineoplastic drugs

Contacts and Locations

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Locations

Austria
Dep. of Pediatrics, Academic Teaching Hospital, Landeskrankenhaus Feldkirch
Feldkirch, Austria, 6900

Sponsors and Collaborators

Landeskrankenhaus Feldkirch

Investigators

Principal Investigator:	Burkhard Simma, MD	Dep. of Pedaitrics Academic Teaching Hospital, Landeskrankenhaus Feldkirch

More Information

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Study Description Study Design Groups and Cohorts Outcome Measures Eligibility Criteria Contacts and Locations More Information

Responsible Party:	Burkhard Simma, Medical Doctor, Professor, Landeskrankenhaus Feldkirch
ClinicalTrials.gov Identifier:	NCT01512030 History of Changes
Other Study ID Numbers:	02
First Posted:	January 19, 2012
Last Update Posted:	September 7, 2016
Last Verified:	September 2016

Additional relevant MeSH terms:

Diabetes Mellitus; Peripheral Nervous System Diseases; Diabetic Neuropathies; Diabetes Mellitus, Type 1; Glucose Metabolism Disorders; Metabolic Diseases	Endocrine System Diseases; Neuromuscular Diseases; Nervous System Diseases; Diabetes Complications; Autoimmune Diseases; Immune System Diseases