Diabetic Neuropathy in Children and Adolescents – a Prospective 5‑year Study

Authors: G. Hajaš 1;  J. Jakubička 2
Authors‘ workplace: FSVaZ UKF a FN Nitra Neurologická klinika 1;  FSVaZ UKF a FN Nitra Pediatrická klinika 2
Published in: Cesk Slov Neurol N 2010; 73/106(1): 51-56
Category: Original Paper


Diabetic neuropathy is the most commonly occurring chronic complication of diabetes, the onset of which depends largely on the duration of the disease. The prevalence of diabetic neuropathy in adult diabetics is estimated at more than 30%; however, the symptomatic forms of neuropathy in children and adolescents with DM are considered rare.

To determine the occurrence of diabetic neuropathy in a definite sample of patients and to investigate whether children and adolescents with type 1 DM still develop peripheral nerve dysfunction despite using modern multiple insulin injection therapy. Methods: 72 young diabetics with type 1 DM were progressively entered into a 5-year prospective study in the years 2001–2003. All patients were treated with modern multiple insulin injection therapy. A total of 66 patients finished the study (92%). Average age was 14.2 years at study entrance; average duration of diabetes at the beginning was 5.4 years. All patients were given a detailed clinical neurological examination, including tactile perception, vibratory perception and electromyographia.

Despite multiple insulin injection therapy, there was an increase of the occurrence of diabetic neuropathy from 24.2 to 42.4% during the 5-year follow-up period. The proportion of patients with asymptomatic (subclinical) neuropathy increased from 13.6 to 25.7% and that of patients with symptomatic (clinical) neuropathy increased from 10.6 to 16.7%. Among the electrophysiological investigations, the highest sensitivity was found in the conduction velocity of the tibial nerve (abnormal in 35% of patients), followed by the conduction velocity of the peroneal and sural nerves.

Young diabetics develop mainly subclinical forms of neuropathy, an unusually important finding in the light of prevention. This study is one of the few that are concerned with the longitudinal follow-up of neuropathy in young diabetics.

Key words:
diabetes mellitus, type 1 – diabetic neuropathy – early diagnosis – electromyography


1. Donaghue KC, Bonney M, Simpson JM, Schwingshandl J, Fung AT, Howard NJ et al. Autonomic and peripheral nerve function in adolescents with and without diabetes. Diabet Med 1993; 10(7): 664–671.

2. Donaghue KC, Silink M. Diabetic neuropathy in childhood. Diabetes Nutr Metab 1999; 12(2): 154–160.

3. Tesfaye S, Stevens LK, Stephenson JM, Fuller JH, Plater M, Ionescu‑Tirgoviste C et al. Prevalence of diabetic peripheral neuropathy and its relation to glycaemic control and potential risk factors: the EURODIAB IDDM Complication Study. Diabetologia 1996; 39(11): 1377–1384.

4. The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long term complications in insulin dependent diabetes mellitus. N Engl J Med 1993; 329(14): 977–986.

5. Bognetti E, Caroli G, Meschi F, Marcellaro P, Bonfanti R, Chiumello G. Prevalence and correlations of early microvascular complications in young type I diabetic patients: role of puberty. J Pediatr Endocrinol Metab 1997; 10(6): 587–592.

6. dos Santos LH, Bruck I, Antoniuk SA, Sandrini R. Evaluation of sensorimotor polyneuropathy in children and adolescents with type I diabetes: associations with microalbuminuria and retinopathy. Pediatr Diabetes 2002; 3(2): 101–108.

7. Solders G, Thalme B, Aguirre‑Aquino M, Brandt L,Berg U, Persson A. Nerve conduction and autonomic nerve function in diabetic children. A 10‑year follow‑up study. Acta Paediatr 1997; 86(4): 361–366.

8. Sosenko JM, Andrew JM, Boulton MRCP, Kubrusly DB, Jagdish K, Weintraub BA et al. The vibratory perception threshold in young diabetic patients: associations with glycaemia and puberty. Diabetes Care 1985, 8: 605–607.

9. Hyllienmark L, Brismar T, Ludvigsson J. Subclinical nerve dysfunction in children and adolescents with IDDM. Diabetologia 1995; 38(6): 685–692.

10. Olsen BS, Nir M, Kjær I, Vølund A, Mortensen HB. Elevated vibration perception threshold in young patients with Type I diabetes in comparison to non‑diabetic children and adolescents. Diabetic Med 1994; 11(9): 888–892.

11. The Diabetes Control and Complications Trial Research Group. The effect of intensive diabetes treatment on the development and progression of long term complications in adolescents with insulin‑dependent diabetes mellitus. Diabetes Control and Complications Trial. J Pediatr 1994; 125(2): 177–188.

12. Olsen BS, Sjølie AK, Hougaard P, Johannesen J, Borch‑Johnsen K, Marinelli K et al. A 6‑year nationwide cohort study of glycaemic control in young people with type I diabetes. Risk markers for the development of retinopathy, nephropathy and neuropathy. J Diabetes Complications 2000; 14(6): 295–300.

13. Dorchy H, Noel P, Kruger M, de Maertelaer V, Dupont E, Toussaint D et al. Peroneal motor nerve conduction velocity in diabetic children and adolescents. Eur J Pediatr 1985; 144(4): 310–315.

14. Käär ML, Saukkonen AL, Pitkänen M, Akerblom HK. Peripheral neuropathy in diabetic children and adolescents. A cross‑sectional study. Acta Paediatr Scand 1983; 72(3): 373–378.

15. Gamstorp I. Normal conduction velocity of ulnar, median and peroneal nerves in infancy, childhood and adolescence. Acta Paediatr Scand 1963; 52 (Suppl 146): 68–76.

16. Ludvigsson J, Johannesson G, Heding L, Hager A, Larsson Y. Sensory nerve conduction velocity and vibratory sensibility in juvenile diabetics. Acta Paediatr Scand 1979; 68(5): 739–743.

17. Dyck PJ. Detection, characterisation and staging of polyneuropathy: assessed in diabetics. Muscle Nerve 1998; 11(1): 21–32.

18. Kurča E, Kučera P. Senzitívny neurogram nervus plantaris medialis v diagnostike diabetickej neuropatie. Neurol pro prax 2002; 3(4): 214–216.

Paediatric neurology Neurosurgery Neurology

Article was published in

Czech and Slovak Neurology and Neurosurgery

Issue 1

2010 Issue 1

Most read in this issue

This topic is also in:

Forgotten password

Don‘t have an account?  Create new account

Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.


Don‘t have an account?  Create new account