The slowing of peripheral nerve conduction velocity in children and adolescents with type 1 diabetes is predicted by glucose fluctuations

figure

posted on 2023-09-12, 22:28 authored by Sarah S. Oberhauser, Dagmar l’Allemand, Erik P.Willems, Tiziana Gozzi, Katrin Heldt, Miriam Eilers, Aikaterini Stasinaki, Jürg Lütschg, Philip J. Broser

Nerve conduction velocity (NCV) abnormalities are the forerunners of diabetic peripheral neuropathy (DPN). As such, the study aimed to analyze the effect of glucose profile quality on NCV in children and young adults with type 1 diabetes. Fifty-three children aged 5 to 23 years with type 1 diabetes were recruited to participate in this study, which was conducted prospectively at the Children’s Hospital of Eastern Switzerland from 2016 to 2022. Glycemic targets were recorded, and a cross-sectional nerve conduction study analyzing the peroneal, tibial, median motor and median sensory nerves was performed. Data were compared with those of a control group of 50 healthy children. In the age- and height-matched diabetes subgroup aged 10 to 16 years, all four nerves showed significantly slower NCV, most pronounced for the peroneal nerve. Because height has a retarding effect on peroneal NCV, NCV was adjusted for height (dNCV). Peroneal dNCV correlated negatively with long-term glycated hemoglobin (mean HbA1c) and highly significantly with glucose variability. Because high glucose variability clearly increases the risk of neuropathy, together with but also independently of the mean glucose level, this aspect of glycemic control should be given more attention in the care of individuals with diabetes.

Article highlights:

There is a strong need for the better identification of early subclinical manifestations of microvascular complications, such as diabetic peripheral neuropathy, already in young people with diabetes.
To identify peripheral neuropathy and contributing factors at an asymptomatic disease stage and to exclude height as a known modifying factor, we performed association studies with height-adjusted nerve conduction velocity.
We identified high glucose variability, especially the standard deviation of mean glucose, as an unexpectedly strong predictor of slowed nerve conduction velocity.
More attention should be paid to the goal of low glucose variability in the care of individuals with diabetes.