Peripheral nerve conduction in youth with type 1 diabetes: A longitudinal analysis of clinical and glycaemic predictors
Aims: In this study of paediatric patients with type 1 diabetes (T1DM), authors correlate nerve conduction study (NCS) findings to identify clinical and continuous glucose monitoring (CGM) predictors of long-term neural dysfunction.
Methods: There were two parts in this study: the first was cross sectional analysis of NCS parameters (peroneal MCV, CMAP, SNCP, SNAP) in 207 children and adolescents with T1DM (mean age 14.0 ± 3.5 years; diabetes duration 6.5 ± 3.5 years) with clinical and glycaemic variables. The second part was longitudinal study of 96 participants with paired examinations over 2 years with the use of logistic regression to find predictors of neural deterioration.
Results: Older age was independently associated with lower peroneal MCV (B = −0.59; p = 0.001). Male sex was associated with higher CMAP values (B = 2.04; p = 0.030), whereas higher 5-year mean HbA1c predicted lower CMAP (B = −3.72; p < 0.001). Longitudinally, higher mean sensor glucose increased the odds of peroneal MCV decline (OR = 1.13; p = 0.025), and longer diabetes duration predicted SNAP deterioration (OR = 1.32; p = 0.021).
Conclusions: The authors conclude that NCS may detect electrophysiological abnormalities consistent with early nerve dysfunction in paediatric type 1 diabetes. In their study, motor NCS parameters may show earlier vulnerability and relate to cumulative glycaemic exposure, whereas sensory axonal involvement may be linked to longer disease duration. Youth with sustained suboptimal glycaemic control should be considered at higher risk for early nerve dysfunction. Incorporating NCS into follow-up may allow timely detection and targeted prevention in this population.
Comments: Diabetes polyneuropathy (DPN) in children and adolescents with T1DM mellitus is now being increasingly recognised as a growing issue. However there remains considerable heterogeneity of data in the terms of incidence and prevalence (3-62%) mainly due to which racial and ethnic differences and the variability of methods used in characterizing and diagnosing neuropathy. The American Diabetes Association (ADA) recommended that all patients with T1DM should be assessed for distal peripheral neuropathy (PN) 5 years following diagnosis, and at least annually after that.
In my opinion, there is now increasing evidence to prove incipient DPN prevalence in children and adolescents with T1DM. So whilst the outcomes in this study as regards inverse correlation with clinical and glycaemic variables is not a surprise, do this outcomes change practice in the paediatric diabetes management where a lot of emphasis continues to remain on glycaemic management alone? The limitations, as is obvious, include single centre studies as well challenges of performing NCS in young children. So, to conclude, some thoughts for NEUROdiab colleagues to consider:
1) Are our measures of small fibre neuropathy which have consistently shown to be more sensitive than large fibre methods in detecting DPN validated for use in children and adolescent? E.g. cornea in children have different thickness, curvature, composition, mechanical strength as well as cell differentiation and adhesion;
2) Is 2-year longitudinal data adequate for characterisation of progression?
Sanjeev Sharma
Reference. Bombaci B, Salzano G, Aramnejad S, Macrì F, Faranna L, Alibrandi A, Rizzo V, Luppino F, Lombardo F, Passanisi S. Peripheral nerve conduction in youth with type 1 diabetes: A longitudinal analysis of clinical and glycemic predictors. Diabet Med. 2026 Jul 11:e70423. doi: 10.1111/dme.70423. Epub ahead of print. PMID: 42435760.
