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Prevalence of Diabetic Peripheral Neuropathy in Youth Nears That of Adults

July 27, 2017
Rates of diabetic peripheral neuropathy in children 0-19 years, especially those with type 2 diabetes, are approaching the levels seen in adults.

Diabetic peripheral neuropathy (DPN) is a common complication experienced by an estimated 30% of adults with diabetes.1  It follows that children and adolescents with diabetes would be at increased risk for developing DPN, and the complications associated with this condition.

To answer this, SEARCH researchers sought to assess the prevalence of DPN in youth (ages 0 to 19 years) and determined that it was 22% for those with type 2 diabetes (T2D) and 7% in children with type 1 diabetes (T1D),2 according to findings published in Diabetes Care.

As such, these high rates of DPN among youth (0 to 19 years) with diabetes are alarming, and pose a need for earlier screening and more aggressive risk factor management, according to the study authors.

Youth with type 2 diabetes are developing peripheral neuropathy at a rate similar to adults.

“Interventions addressing dyslipidemia and deregulated glycemic control could avert or postpone the development of DPN,” said Mamta Jaiswal, PhD, a neurology researcher at the University of Michigan Medical School in Ann Arbor.

Screening for poor glycemic control and dyslipidemia and initiating strategies earlier in children and adolescents may go a long way to prevent or delay debilitating neuropathic complications. 

SEARCH Methodology for Peripheral Neuropathy

 In 2000, SEARCH—a 10-year collaborative, multicenter research program— was initiated by the Centers for Disease Control and Prevention—to follow children under age 20 years with diabetes.3

SEARCH is a population-based, prospective cohort study.3 Participants were identified from incident cases of diabetes diagnosed between 2002 and 2006 from Ohio, Washington, South Carolina, Colorado, and California, as well as Indian Health Service beneficiaries in American Indian populations in Arizona and New Mexico. This study is the first to examine the prevalence of DPN in a racially/ethnically diverse cohort of young patients with diabetes in the United States. 

Researchers used the Michigan Neuropathy Screening Instrument (MNSI) to examined DPN in 1,734 young patients with T1D (age 18 ± 4 years, T1D duration 7.2 ± 1.2 years) and 258 youth with T2D (age 22.0 ± 3.5 years).4

The MNSI score (>2) defined DPN in this study,1,4 which included both a self-administered patient questionnaire and a physical examination that included a:

A Closer Look at Risk Factors

In patients with T2D, the risk factors that increased the likelihood of developing T2D were older age, male sex, longer duration of diabetes, smoking, and lower HDL cholesterol (HDL-C).1

Among individuals with T1D, the factors identified as increasing the risk for developing DPN were older age, longer duration of diabetes, smoking, increased diastolic blood pressure, obesity, increased LDL cholesterol and triglycerides, and lower HDL-C .1

Patients with T1D and DPN experienced worsening glycemic control over time (odds ratio 1.53 [95% CI, 1.24-1.88]), though this correlation did not persist in youth with T2D (1.05 [0.7; 1.56]).1

DNP Progression Requires Earlier Screening, Intervention

In the T1D group,1 the average duration of disease was 7.2 ± 1.2 years, and the average HbA1c was 9.1 ± 1.9%.1 Among children with T2D, the average duration of disease was 7.9 ± 2 years, and the average HbA1c was 9.4 ± 2.3%.1 All enrolled patients experienced ≥ 5 years of duration of disease.

In adult patients with newly diagnosed diabetes, the prevalence of DPN ranges from 10% to 30%,2 suggesting that the rate of DPN seen in the young patients with T2D is similar to that of adults.

These findings reinforce a rate of diabetic complications in patients with T2D that is 2 to 3 times higher than those observed in patients with T1D.5 Additionally, the lower rates of HDL-c, which is known to have protective effects on health, could contribute to the pathophysiology of DPN observed in these young patients.1

Last updated on: August 3, 2017
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