Evidence-Based Assessment of Pediatric Diabetic Peripheral Neuropathy
Todd O’Brien*
Penobscot Community Health Care, USA
Submission: January 24, 2019; Published: February 22, 2019
*Corresponding author: Todd O’Brien, Penobscot community health care, 16 Winterhaven Drive Orono, ME 04473, USA
How to cite this article: Todd O’Brien. Evidence-Based Assessment of Pediatric Diabetic Peripheral Neuropathy. Curre Res Diabetes & Obes J. 2019; 9(5): 555773. DOI: 10.19080/CRDOJ.2019.09.555774
Keywords:Global burden; Diabetes; Pediatric population; Childhood obesity; Type 2 diabetes; Diabetic peripheral neuropathy; Biothesiometer; Diabetic neuropathy
Mini Review
The global burden of diabetes is currently estimated at 425 million and rising [1]. Unfortunately, this well-documented increase in diabetes among adults is mirrored by a similar trend in the pediatric population [2-4]. Further analysis reveals a disturbing increase in Type 2 diabetes among these patients which some have linked to a rise in childhood obesity [5].
This combination of diabetes and obesity in adulthood can lead to devastating foot complications including lower extremity amputations. Another one of the essential precursors on the path to limb loss is diabetic peripheral neuropathy (DPN). Although neurological screening for DPN is routine in adults, pediatric patients often are not assessed for this complication. Despite the fact that up to 25% of pediatric diabetic patients have neuropathy, the majority are subclinical possibly explaining this oversight [6]. Furthermore, widely accepted guidelines for neurological screening in this patient population have not been established. Although several studies have evaluated the efficacy of screening tools currently in use, consensus has not been reached on a standardized approach [7]. A summary of relevant research on this topic is found in Table 1.
Evidence-Based Recommendations
In light of the known potential complications in adulthood, most experts recommend routine screening for early neuropathy in pediatric diabetic patients even when the condition is subclinical. Research has shown NCVs to be the gold standard for neurological assessment in adult and pediatric patients. Unfortunately, this test is invasive, painful, expensive and time-consuming. A more practical screening method is assessment of vibration perception thresholds (VPTs) with a biothesiometer (Figure 1). Although this method is painless and non-invasive, most clinicians have not purchased the device. Additionally, the test can take several minutes to perform properly and usually requires a dedicated space as the biothesiometer is large and relies on a wall outlet for power.
Another alternative is the newly available ETF128 (Figure 2). This portable, point-of-care instrument combines the standardization of the biothesiometer with the ease of use and speed of the traditional tuning fork test. An integrated timer allows clinicians to perform accurate timed vibration tests to rapidly gauge large fiber nerve function [10,11]. The numerical value obtained from this test can be used to track nerve function over time. A scale on the device provides guidance on levels of neuropathy present. Although new to the market, it is ideally suited to the assessment of diabetic neuropathy in adult and pediatric patients.
References
- (2015) IDF Diabetes Atlas, International Diabetes Federation.
- Patterson C, Guariguata L, Dahlquist G, Soltész G, Ogle G, et al. (2014) Diabetes in the young – a global view and worldwide estimates of numbers of children with type 1 diabetes. Diabetes Res Clin Pract 103(2): 161-175.
- Dabelea D, Mayer-Davis EJ, Saydah S, Imperatore G, Linder B, et al. (2014) Prevalence of Type 1 and Type 2 Diabetes Among Children and Adolescents From 2001 to 2009. JAMA 311(17): 1778-1786.
- Hamman RF, Bell RA, Dabelea D, D'Agostino RB Jr, Dolan L, et al. (2014) The SEARCH for Diabetes in Youth Study: Rationale, Findings, and Future Directions. Diabetes Care 37(12): 3336-3344.
- Propst M, Colvin C, Griffin RL, Sunil B, Harmon CM, et al. (2015) Diabetes and Pre-Diabetes Significantly Higher in Morbidly Obese Children Compared to Obese Children. Endocr Pract 21(9): 1046-1053.
- Hasani N, Khosrawi S, Hashemipour M, Haghighatiyan M, Javdan Z, et al. (2013) Prevalence of related risk-factors of peripheral neuropathy in children with insulin-dependent diabetes mellitus. J Res Med Sci 18(2): 132-136.
- Mah JK, Pacaud D (2014) Diabetic neuropathy in children. Handb Clin Neurol 126: 123-143.
- Hirschfeld G, von Glischinski M, Blankenburg M, Zernikow B (2014) Screening for Peripheral Neuropathies in Children with Diabetes: A Systematic Review. Pediatrics 133(5): e1324-e1330.
- Olsen BS, Nir M, Kjaer I, Vølund A, Mortensen HB (1994) Elevated vibration perception threshold in young patients with type 1 diabetes in comparison to non-diabetic children and adolescents. Diabet Med 11(9): 888-892.
- O’Brien T, Karem J (2014) An Initial Evaluation of a Proof-of-Concept 128-Hz Electronic Tuning Fork in the Detection of Peripheral Neuropathy. J Am Podiatr Med Assoc 104(2): 134-140.
- O’Brien T, Karem J (2013) Relative sensory sparing in the diabetic foot implied through vibration testing. Diabetic Foot & Ankle 4: 21278.