Point Prevalence of Peripheral Neuropathy in Children and Adolescents with Type 1 Diabetes Mellitus

OBJECTIVE

To assess the point prevalence of peripheral neuropathy (PN) in children with type 1 diabetes mellitus (T1DM) and to determine their predictors.

METHODS

In this cross-sectional study, children aged 8-18 y with T1DM on insulin therapy for > 2 y and free from acute complications were enrolled. All participants were evaluated for symptoms of PN with diabetic neuropathy symptom (DNS) score and underwent a detailed neurological examination. Assessment of nerve dysfunction was done using nerve conduction studies (NCS). The disease-related factors that increase the risk of PN were determined.

RESULTS

Fifty children (52% boys) were enrolled with mean age of 12.2 ± 2.8 y and duration of diabetes 5.1 ± 2.1 y. No subject had clinical evidence or DNS score suggestive of PN. Twenty-eight (56%) children demonstrated subclinical neuropathy on NCS. Proportion of children with pure motor, pure sensory, and mixed motor-sensory neuropathy was 40%, 2%, and 14%, respectively. The peroneal nerve was the most common motor nerve affected. Poor glycemic control (HbA1c > 9%) and longer duration of diabetes (> 5 y) were significantly associated with the risk of PN (p value < 0.05).

CONCLUSION

A large proportion of children with T1DM have subclinical PN. Poor glycemic control and longer duration of diabetes are risk factors for nerve dysfunction. Neurophysiological studies should be performed in these children to facilitate early detection.

Nerve Conduction Study on Sural Nerve among Nepalese Tailors Using Mechanical Sewing Machine

INTRODUCTION

The use of new technologies and innovations are out of access for people living in a developing country like Nepal. The mechanical sewing machine is still in existence at a large scale and dominant all over the country. Tailoring is one of the major occupations adopted by skilled people with lower socioeconomic status and education level. Sural nerves of both right and left legs are exposed to strenuous and chronic stress exerted by chronic paddling of mechanical sewing machine with legs.

AIM

To evaluate the influence of chronic and strenuous paddling on right and left sural nerves.

MATERIALS AND METHODS

The study recruited 30 healthy male tailors with median age {34(31-37.25)} years (study group), and, 30 healthy male volunteers with age {34(32-36.25)} years (control group). Anthropometric measurements (age, height, weight, BMI and length of both right and left legs) as well as cardio respiratory measurements [Systolic Blood Pressure (SBP), Dystolic Blood Pressure (DBP), Pules Rate (PR) and Respiratory Rate (RR)] were recorded for each subject. Standard nerve conduction techniques using constant measured distances were applied to evaluate sural nerve (sensory) in both legs of each individual. The differences in variables between the study and control groups were tested using Student's t-test for parametric variables and Mann-Whitney U test for nonparametric variables. A p-value of ≤ 0.05 was considered significant.

RESULTS

Age, height, weight, body mass index and leg length were not significantly different between tailors and control groups. Cardio respiratory measurements (SBP, DBP, PR and RR) were also not significantly altered between both the groups. The sensory nerve conduction velocities (m/s) of the right {44.23(42.72-47.83) vs 50(46- 54)} and left sural nerves {45.97±5.86 vs 50.67±6.59} m/s were found significantly reduced in tailors in comparison to control group. Similarly amplitudes (μv) of right sural (20.75±5.42 vs 24.10±5.45) and left sural nerves {18.2(12.43-21.8) vs 32.0(26.5-35.25)} were significantly less in tailors in comparison to control group whereas, latencies (ms) of right sural {2.6(2.2-2.7) vs 2.0(2.0-2.250} and left sural nerve {2.4(2.07-2.72) vs 2.0(2.0-2.0)} were found significantly high in tailors as compared with control group.

CONCLUSION

Operating mechanical sewing machine by paddling chronically and arduously could have attributed to abnormal nerve conduction study parameters due to vibration effect of the machine on right and left sural nerves. The results of present study follow the trend towards presymptomatic or asymptomatic neuropathy similar to subclinical neuropathy.