Home Medicine Neuropathy in paediatric type 1 diabetes mellitus – clinical characterization and analysis of risk factors in the diabetes prospective follow-up registry DPV (Diabetes-Patienten-Verlaufsdokumentation)-registry
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Neuropathy in paediatric type 1 diabetes mellitus – clinical characterization and analysis of risk factors in the diabetes prospective follow-up registry DPV (Diabetes-Patienten-Verlaufsdokumentation)-registry

  • Angeliki Pappa ORCID logo EMAIL logo , Martin G. Haeusler ORCID logo , Sascha R. Tittel , Claudia Boettcher , Doerte Hilgard , Sabine Knauer-Fischer , Marianne Pavel , Joachim Woelfle and Reinhard W. Holl
Published/Copyright: June 12, 2023
Journal of Pediatric Endocrinology and Metabolism
From the journal Journal of Pediatric Endocrinology and Metabolism Volume 36 Issue 7

Abstract

Objectives

Data on the prevalence, clinical features and risk factors associated with paediatric diabetic neuropathy (DN) are scarce.

Methods

We retrospectively analysed data from the DPV registry, including patients under 20 years of age, treated for type 1 diabetes mellitus (T1D) between 2005 and 2021. Patients with non-diabetic neuropathy were excluded. Data came from centres in Austria, Germany, Luxembourg and Switzerland.

Results

1,121 of the 84,390 patients included had been diagnosed with DN. Univariate analysis showed patients with DN to be older and predominantly female, with a longer duration of T1D, higher insulin dosages per kg and day, lower rates of insulin pump therapy, higher postprandial glucose-, higher HbA1c-and higher cholesterol levels, and higher diastolic and systolic blood pressure values. There was also a larger proportion of smokers and higher prevalence of diabetic retinopathy. Median duration of diabetes at diagnosis of DN was 8.3 years. Multivariable analysis, adjusted for demographics revealed an increased risk for DN among female patients and those who were older, underweight (BMI-SDS), smoked cigarettes or had a longer duration of T1D or higher levels of HbA1c and postprandial blood glucose. The presence of retinopathy and higher cholesterol levels were also linked to increased risk while not-using insulin pump therapy was not.

Conclusions

DN can develop after just a short duration of T1D. Prevention may be achieved by a lowering of HbA1c-and postprandial glucose levels through improved glycaemic control. This warrants further investigation. The slight female predominance suggests further hormonal and genetic etiological factors.

Keywords: autonomic dysfunction; childhood diabetes; diabetic neuropathy; DPV; small fiber neuropathy; type 1 diabetes mellitus
Corresponding author: Dr. Angeliki Pappa, Department of Paediatrics, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074 Aachen, Germany, Phone: +49.241.800, Fax: +49.241.8082484, E-mail:
Angeliki Pappa and Martin G. Haeusler contributed equally to this work.

Funding source: The DPV is supported through the German Federal Ministry for Education and Research within the German Centre for Diabetes Research (DZD,)

Award Identifier / Grant number: grant number: 82DZD14A02

Funding source: Interdisciplinary Centre for Clinical Research within the faculty of Medicine at the RWTH Aachen University

Award Identifier / Grant number: (IZKF TN1-8/IA 532008)

Acknowledgments

(DPV=Diabetes-Patientenverlaufsdokumentation). Special thanks to A. Hungele and R. Ranz for support and developing of the DPV documentation software (clinical data managers, Ulm University) and to Laura Bell (audiovisuelles Medienzentrum UKA). We further wish to thank all centres contributing to this analysis. Details can be found in supplement “Centres”.

  1. Research funding: The DPV is supported through the German Federal Ministry for Education and Research within the German Centre for Diabetes Research (DZD, grant number: 82DZD14A02).

  2. Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.

  3. Competing interests: Authors state no conflict of interest.

  4. Informed consent: Informed consent was obtained from all individuals included in this study.

  5. Ethical approval: The local Institutional Review Board deemed the study exempt from review. The study was approved by the ethics committee of Ulm university (leading study site) and by the ethics committees of all further contributing centers.

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Received: 2023-02-20
Accepted: 2023-05-21
Published Online: 2023-06-12
Published in Print: 2023-07-26

© 2023 Walter de Gruyter GmbH, Berlin/Boston

Articles in the same Issue

  1. Frontmatter
  2. Review Article
  3. Molecular mechanisms involved in fetal programming and disease origin in adulthood
  4. Original Articles
  5. Neuropathy in paediatric type 1 diabetes mellitus – clinical characterization and analysis of risk factors in the diabetes prospective follow-up registry DPV (Diabetes-Patienten-Verlaufsdokumentation)-registry
  6. Effect of metabolic control on cognitive functions in children and adolescents with type 1 diabetes mellitus
  7. Uric acid and sCD163 as biomarkers for metabolic dysfunction and MAFLD in children and adolescents with overweight and obesity
  8. Endocrinological, immunological and metabolic features of patients with Fabry disease under therapy
  9. Evaluation and management of pediatric thyroid nodules and thyroid cancer at a single institution after adoption of the American Thyroid Association 2015 guidelines
  10. Fasting ketone levels vary by age: implications for differentiating physiologic from pathologic ketotic hypoglycemia
  11. Association of adipocytokines and adipocytokine ratios with cardiovascular risk factors in Japanese preadolescents
  12. Daily vs. monthly oral vitamin D3 for treatment of symptomatic vitamin D deficiency in infants: a randomized controlled trial
  13. Short Communication
  14. Management and outcomes in secondary diabetes among pediatric patients hospitalized with hemophagocytic lymphohistiocytosis
  15. Letter to the Editor
  16. Potential usefulness of assessing serum betamethasone levels during betamethasone therapy
  17. Case Reports
  18. Acquired idiopathic isolated ACTH deficiency with associated autoimmune thyroiditis in pediatrics: case report and review of the literature
  19. A very rare cause of hypertrygliseridemia in infancy: a novel mutation in glycerol-3-phosphate dehydrogenase 1 (GPD1) gene
  20. Difficult to think about but easy to treat: scurvy
  21. Severe hypophosphataemia can be an early sign of osteopetrorickets: a case report
  22. Corrigendum
  23. Diagnosis of adrenal insufficiency in children: a survey among pediatric endocrinologists in North America
https://doi.org/10.1515/jpem-2023-0074
Keywords for this article
autonomic dysfunction; childhood diabetes; diabetic neuropathy; DPV; small fiber neuropathy; type 1 diabetes mellitus

Articles in the same Issue

  1. Frontmatter
  2. Review Article
  3. Molecular mechanisms involved in fetal programming and disease origin in adulthood
  4. Original Articles
  5. Neuropathy in paediatric type 1 diabetes mellitus – clinical characterization and analysis of risk factors in the diabetes prospective follow-up registry DPV (Diabetes-Patienten-Verlaufsdokumentation)-registry
  6. Effect of metabolic control on cognitive functions in children and adolescents with type 1 diabetes mellitus
  7. Uric acid and sCD163 as biomarkers for metabolic dysfunction and MAFLD in children and adolescents with overweight and obesity
  8. Endocrinological, immunological and metabolic features of patients with Fabry disease under therapy
  9. Evaluation and management of pediatric thyroid nodules and thyroid cancer at a single institution after adoption of the American Thyroid Association 2015 guidelines
  10. Fasting ketone levels vary by age: implications for differentiating physiologic from pathologic ketotic hypoglycemia
  11. Association of adipocytokines and adipocytokine ratios with cardiovascular risk factors in Japanese preadolescents
  12. Daily vs. monthly oral vitamin D3 for treatment of symptomatic vitamin D deficiency in infants: a randomized controlled trial
  13. Short Communication
  14. Management and outcomes in secondary diabetes among pediatric patients hospitalized with hemophagocytic lymphohistiocytosis
  15. Letter to the Editor
  16. Potential usefulness of assessing serum betamethasone levels during betamethasone therapy
  17. Case Reports
  18. Acquired idiopathic isolated ACTH deficiency with associated autoimmune thyroiditis in pediatrics: case report and review of the literature
  19. A very rare cause of hypertrygliseridemia in infancy: a novel mutation in glycerol-3-phosphate dehydrogenase 1 (GPD1) gene
  20. Difficult to think about but easy to treat: scurvy
  21. Severe hypophosphataemia can be an early sign of osteopetrorickets: a case report
  22. Corrigendum
  23. Diagnosis of adrenal insufficiency in children: a survey among pediatric endocrinologists in North America
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