Neuropathy in adolescents with type 1 diabetes: Confirmatory diagnostic tests, bedside tests, and risk factors

Vinni Faber Rasmussen; Mathilde Thrysøe; Jens Randel Nyengaard; Hatice Tankisi; Páll Karlsson; John Hansen; Klaus Krogh; Christina Brock; Konstantinos Kamperis; Mette Madsen; Wolfgang Singer; Esben Thyssen Vestergaard; Kurt Kristensen; Astrid Juhl Terkelsen

doi:10.1016/j.diabres.2023.110736

Neuropathy in adolescents with type 1 diabetes: Confirmatory diagnostic tests, bedside tests, and risk factors

Vinni Faber Rasmussen^*, Mathilde Thrysøe, Jens Randel Nyengaard, Hatice Tankisi, Páll Karlsson, John Hansen, Klaus Krogh, Christina Brock, Konstantinos Kamperis, Mette Madsen, Wolfgang Singer, Esben Thyssen Vestergaard, Kurt Kristensen, Astrid Juhl Terkelsen

^*Corresponding author for this work

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

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Abstract

AIMS: To estimate the prevalence of large fiber (LFN), small fiber (SFN), and autonomic neuropathy in adolescents with type 1 diabetes using confirmatory tests known from adults and to identify risk factors and bedside methods for neuropathy.

METHODS: Sixty adolescents with type 1 diabetes (diabetes duration>five years) and 23 control subjects underwent neurological examination and confirmatory diagnostic tests for neuropathy, including nerve conduction studies, skin biopsies determining intraepidermal nerve fiber density, quantitative sudomotor axon reflex test (QSART), cardiovascular reflex tests (CARTs), and tilt table test. Possible risk factors were analyzed. Bedside tests (biothesiometry, DPNCheck®, Sudoscan, and Vagus®device) were compared with the confirmatory tests using ROC analysis.

RESULTS: The prevalence of neuropathies in the adolescents with diabetes (mean HbA1c 7.6% (60 mmol/mol)) was as follows: 14% confirmed/26% subclinical LFN, 2% confirmed/25% subclinical SFN, 20% abnormal QSART, 8% abnormal CARTs, and 14% orthostatic hypotension. Higher age, higher insulin dose, previous smoking, and higher triglycerides level were found to increase the relative risk for neuropathy. The bedside tests showed poor to acceptable concordance with the confirmatory tests (all, AUC ≤ 0.75).

CONCLUSIONS: The diagnostic tests confirmed the presence of neuropathy in adolescents with diabetes and underscore the importance of prevention and screening.

Original language	English
Article number	110736
Journal	Diabetes Research and Clinical Practice
Volume	201
Number of pages	9
ISSN	0168-8227
DOIs	https://doi.org/10.1016/j.diabres.2023.110736
Publication status	Published - Jul 2023

Keywords

Adolescents
Neuropathy
Risk factors
Screening methods
Type 1 diabetes
Humans
Risk Factors
Diabetes Mellitus, Type 1/complications
Neural Conduction/physiology
Diagnostic Tests, Routine
Peripheral Nervous System Diseases
Adolescent
Adult

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Faber Rasmussen, V., Thrysøe, M., Randel Nyengaard, J., Tankisi, H., Karlsson, P., Hansen, J., Krogh, K., Brock, C., Kamperis, K., Madsen, M., Singer, W., Thyssen Vestergaard, E., Kristensen, K., & Juhl Terkelsen, A. (2023). Neuropathy in adolescents with type 1 diabetes: Confirmatory diagnostic tests, bedside tests, and risk factors. Diabetes Research and Clinical Practice, 201, Article 110736. https://doi.org/10.1016/j.diabres.2023.110736

@article{adee9a05b5dc45b1a8ef4827c120f823,

title = "Neuropathy in adolescents with type 1 diabetes: Confirmatory diagnostic tests, bedside tests, and risk factors",

abstract = "AIMS: To estimate the prevalence of large fiber (LFN), small fiber (SFN), and autonomic neuropathy in adolescents with type 1 diabetes using confirmatory tests known from adults and to identify risk factors and bedside methods for neuropathy.METHODS: Sixty adolescents with type 1 diabetes (diabetes duration>five years) and 23 control subjects underwent neurological examination and confirmatory diagnostic tests for neuropathy, including nerve conduction studies, skin biopsies determining intraepidermal nerve fiber density, quantitative sudomotor axon reflex test (QSART), cardiovascular reflex tests (CARTs), and tilt table test. Possible risk factors were analyzed. Bedside tests (biothesiometry, DPNCheck{\textregistered}, Sudoscan, and Vagus{\textregistered}device) were compared with the confirmatory tests using ROC analysis.RESULTS: The prevalence of neuropathies in the adolescents with diabetes (mean HbA1c 7.6% (60 mmol/mol)) was as follows: 14% confirmed/26% subclinical LFN, 2% confirmed/25% subclinical SFN, 20% abnormal QSART, 8% abnormal CARTs, and 14% orthostatic hypotension. Higher age, higher insulin dose, previous smoking, and higher triglycerides level were found to increase the relative risk for neuropathy. The bedside tests showed poor to acceptable concordance with the confirmatory tests (all, AUC ≤ 0.75).CONCLUSIONS: The diagnostic tests confirmed the presence of neuropathy in adolescents with diabetes and underscore the importance of prevention and screening.",

keywords = "Adolescents, Neuropathy, Risk factors, Screening methods, Type 1 diabetes, Humans, Risk Factors, Diabetes Mellitus, Type 1/complications, Neural Conduction/physiology, Diagnostic Tests, Routine, Peripheral Nervous System Diseases, Adolescent, Adult",

author = "{Faber Rasmussen}, Vinni and Mathilde Thrys{\o}e and {Randel Nyengaard}, Jens and Hatice Tankisi and P{\'a}ll Karlsson and John Hansen and Klaus Krogh and Christina Brock and Konstantinos Kamperis and Mette Madsen and Wolfgang Singer and {Thyssen Vestergaard}, Esben and Kurt Kristensen and {Juhl Terkelsen}, Astrid",

year = "2023",

month = jul,

doi = "10.1016/j.diabres.2023.110736",

language = "English",

volume = "201",

journal = "Diabetes Research and Clinical Practice",

issn = "0168-8227",

publisher = "Elsevier Ireland Ltd",

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Faber Rasmussen, V, Thrysøe, M, Randel Nyengaard, J , Tankisi, H , Karlsson, P, Hansen, J, Krogh, K , Brock, C , Kamperis, K, Madsen, M, Singer, W, Thyssen Vestergaard, E , Kristensen, K & Juhl Terkelsen, A 2023, 'Neuropathy in adolescents with type 1 diabetes: Confirmatory diagnostic tests, bedside tests, and risk factors', Diabetes Research and Clinical Practice, vol. 201, 110736. https://doi.org/10.1016/j.diabres.2023.110736

Neuropathy in adolescents with type 1 diabetes: Confirmatory diagnostic tests, bedside tests, and risk factors. / Faber Rasmussen, Vinni; Thrysøe, Mathilde; Randel Nyengaard, Jens et al.
In: Diabetes Research and Clinical Practice, Vol. 201, 110736, 07.2023.

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

TY - JOUR

T1 - Neuropathy in adolescents with type 1 diabetes

T2 - Confirmatory diagnostic tests, bedside tests, and risk factors

AU - Faber Rasmussen, Vinni

AU - Thrysøe, Mathilde

AU - Randel Nyengaard, Jens

AU - Tankisi, Hatice

AU - Karlsson, Páll

AU - Hansen, John

AU - Krogh, Klaus

AU - Brock, Christina

AU - Kamperis, Konstantinos

AU - Madsen, Mette

AU - Singer, Wolfgang

AU - Thyssen Vestergaard, Esben

AU - Kristensen, Kurt

AU - Juhl Terkelsen, Astrid

PY - 2023/7

Y1 - 2023/7

N2 - AIMS: To estimate the prevalence of large fiber (LFN), small fiber (SFN), and autonomic neuropathy in adolescents with type 1 diabetes using confirmatory tests known from adults and to identify risk factors and bedside methods for neuropathy.METHODS: Sixty adolescents with type 1 diabetes (diabetes duration>five years) and 23 control subjects underwent neurological examination and confirmatory diagnostic tests for neuropathy, including nerve conduction studies, skin biopsies determining intraepidermal nerve fiber density, quantitative sudomotor axon reflex test (QSART), cardiovascular reflex tests (CARTs), and tilt table test. Possible risk factors were analyzed. Bedside tests (biothesiometry, DPNCheck®, Sudoscan, and Vagus®device) were compared with the confirmatory tests using ROC analysis.RESULTS: The prevalence of neuropathies in the adolescents with diabetes (mean HbA1c 7.6% (60 mmol/mol)) was as follows: 14% confirmed/26% subclinical LFN, 2% confirmed/25% subclinical SFN, 20% abnormal QSART, 8% abnormal CARTs, and 14% orthostatic hypotension. Higher age, higher insulin dose, previous smoking, and higher triglycerides level were found to increase the relative risk for neuropathy. The bedside tests showed poor to acceptable concordance with the confirmatory tests (all, AUC ≤ 0.75).CONCLUSIONS: The diagnostic tests confirmed the presence of neuropathy in adolescents with diabetes and underscore the importance of prevention and screening.

AB - AIMS: To estimate the prevalence of large fiber (LFN), small fiber (SFN), and autonomic neuropathy in adolescents with type 1 diabetes using confirmatory tests known from adults and to identify risk factors and bedside methods for neuropathy.METHODS: Sixty adolescents with type 1 diabetes (diabetes duration>five years) and 23 control subjects underwent neurological examination and confirmatory diagnostic tests for neuropathy, including nerve conduction studies, skin biopsies determining intraepidermal nerve fiber density, quantitative sudomotor axon reflex test (QSART), cardiovascular reflex tests (CARTs), and tilt table test. Possible risk factors were analyzed. Bedside tests (biothesiometry, DPNCheck®, Sudoscan, and Vagus®device) were compared with the confirmatory tests using ROC analysis.RESULTS: The prevalence of neuropathies in the adolescents with diabetes (mean HbA1c 7.6% (60 mmol/mol)) was as follows: 14% confirmed/26% subclinical LFN, 2% confirmed/25% subclinical SFN, 20% abnormal QSART, 8% abnormal CARTs, and 14% orthostatic hypotension. Higher age, higher insulin dose, previous smoking, and higher triglycerides level were found to increase the relative risk for neuropathy. The bedside tests showed poor to acceptable concordance with the confirmatory tests (all, AUC ≤ 0.75).CONCLUSIONS: The diagnostic tests confirmed the presence of neuropathy in adolescents with diabetes and underscore the importance of prevention and screening.

KW - Adolescents

KW - Neuropathy

KW - Risk factors

KW - Screening methods

KW - Type 1 diabetes

KW - Humans

KW - Risk Factors

KW - Diabetes Mellitus, Type 1/complications

KW - Neural Conduction/physiology

KW - Diagnostic Tests, Routine

KW - Peripheral Nervous System Diseases

KW - Adolescent

KW - Adult

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U2 - 10.1016/j.diabres.2023.110736

DO - 10.1016/j.diabres.2023.110736

M3 - Journal article

C2 - 37276985

SN - 0168-8227

VL - 201

JO - Diabetes Research and Clinical Practice

JF - Diabetes Research and Clinical Practice

M1 - 110736

ER -

Neuropathy in adolescents with type 1 diabetes: Confirmatory diagnostic tests, bedside tests, and risk factors

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Corrigendum to "Neuropathy in adolescents with type 1 diabetes: Confirmatory diagnostic tests, bedside tests, and risk factors” [Diab. Res. Clin. Pract. 201 (2023) 110736]

Letter to the Editor in response to the letter regarding the article “Neuropathy in adolescents with type 1 diabetes: Confirmatory diagnostic tests, bedside tests, and risk factors”

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