Neuropathies in children with diabetes mellitus - abstract

ABSTRACT

Type I diabetes mellitus has a prevalence in the tropical climates significantly less than in more temperate climates. The incidence rates are greater for Caucasians than Blacks or Orientals and, in the paediatric population, has a bimodal age presentation 6 - 8 years and 12 - 15 years. The onset has no sex preponderance but has a seasonal variation, occurring in the cooler months. An increased incidence is also noted with outbreaks of viral respiratory diseases. The strong association with histocompatibility groups B8/B15 and D3/D4 has been well documented and HLA B7 is though to have a possible protective effect. Diabetic complications in childhood tend to be primarily acute conditions such as ketoacidosis hypoglycaemia, cataracts and mononeuropathies. The chronic complications are significantly less common in childhood and include growth and pubertal delay, retinopathy, nephropathy, neuropathy and dermatological disorders. Diabetic neuropathy may be classified simply into - distal symmetric polyneuropathy + autonomic neuropathy, - mononeuropathies, - proximal/motor neuropathy. The diagnosis of diabetic neuropathy has been controversial; however, various criteria have been applied involving Neuropthic Symptom Score (NSS), Neuropathy Disability Score (NDS), Quantitative Sensory Testing (QST), Electrophysiological Studies. No specific studies in the literature relate to children under 17 years of age with diabetic neuropathy. The Pittsburh Epidemiology Deibetes Complications Study looked at individuals diagnosed prior to 17 years of and found that the prevalence of diabetic neuropathy increases with both age and duration of diabetes. It noted a prevalene rate of 30 percent at 20 years' duration of disease. The use of QST and electrophysiological studies increased the prevalence significantly in this study. These data were also supported by a multicentre UK hospital clinic population study which in addition showed a prevalence rate of 5 percent in the 20 - 29-year-age group vs 44 percent in the 70 -79-year age group. In conclusion, diabetic neuropathy is uncommon in childhood, with a prevalence that increases with age and disease duration. There is a need for techniques to allow earlypre-clinical diagnosis which are easily apllicable. This will allow for more studies to be done in children and enable better understanding of the early phase of diabetic neuropathy (AU)