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

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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.

Originalsprog	Engelsk
Artikelnummer	110736
Tidsskrift	Diabetes Research and Clinical Practice
Vol/bind	201
Antal sider	9
ISSN	0168-8227
DOI	https://doi.org/10.1016/j.diabres.2023.110736
Status	Udgivet - jul. 2023

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10.1016/j.diabres.2023.110736Licens: CC BY 4.0

Open Access articleForlagets udgivne version, 1,58 MBLicens: CC BY 4.0

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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, Artikel 110736. https://doi.org/10.1016/j.diabres.2023.110736

@article{531c7bc762424a64b4583ae110e11ab2,

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

abstract = "AimsTo 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.MethodsSixty 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.ResultsThe 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).ConclusionsThe 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",

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",

note = "A corrigendum has been published: https://doi.org/10.1016/j.diabres.2023.110949 The authors regret some counting and typographical errors in Table 3. There have been errors in the extraction of some of the count data for the 2x2 tables, where a few numbers have been based on previous results due to a missing reading of a code in R. These errors were present in only a few of the results, and they do not alter the main findings of that higher insulin dose per kilogram per day, previous smoking, and higher triglyceride levels were found to increase the relative risk for neuropathy. Remarkably, the relative risk ratio and confidence intervals should be interpreted cautiously due to the small population in the study. Copyright {\textcopyright} 2023. Published by Elsevier B.V.",

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",

}

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, bind 201, 110736. https://doi.org/10.1016/j.diabres.2023.110736

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

N1 - A corrigendum has been published: https://doi.org/10.1016/j.diabres.2023.110949 The authors regret some counting and typographical errors in Table 3. There have been errors in the extraction of some of the count data for the 2x2 tables, where a few numbers have been based on previous results due to a missing reading of a code in R. These errors were present in only a few of the results, and they do not alter the main findings of that higher insulin dose per kilogram per day, previous smoking, and higher triglyceride levels were found to increase the relative risk for neuropathy. Remarkably, the relative risk ratio and confidence intervals should be interpreted cautiously due to the small population in the study. Copyright © 2023. Published by Elsevier B.V.

PY - 2023/7

Y1 - 2023/7

N2 - AimsTo 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.MethodsSixty 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.ResultsThe 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).ConclusionsThe diagnostic tests confirmed the presence of neuropathy in adolescents with diabetes and underscore the importance of prevention and screening.

AB - AimsTo 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.MethodsSixty 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.ResultsThe 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).ConclusionsThe 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

UR - http://www.scopus.com/inward/record.url?scp=85161345758&partnerID=8YFLogxK

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

Abstract

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