Single sural nerve response: A reliable and practical method for diagnosis of diabetic peripheral neuropathy in children with type 1 diabetes

Abstract

Objectives

Type 1 diabetes mellitus (T1DM) is a significant global health issue, particularly due to its association with microvascular complications such as diabetic peripheral neuropathy (DPN). Sensory nerves in the lower extremities are primarily affected by DPN, with the sural nerve being particularly impacted. The conventional method for diagnosing DPN involves evaluating four motor and four sensory nerves in the upper and lower extremities. Motor tests use dual-point high-intensity stimulation to elicit a compound muscle action potential, while sensory tests apply a single, lower-intensity stimulus to assess depolarized nerve fibers. The aim of this study was to define the efficacy of using a single sural nerve response for the diagnosis of DPN in pediatric T1DM patients compared to the conventional method.

Methods

This retrospective study analyzed data from 242 patients, including 204 with T1DM and 38 controls. For T1DM patients, we evaluated risk factors for DPN, including age, gender, hemoglobin A1c levels, lipid parameters, and body mass index. Nerve conduction studies were evaluated in both groups.

Results

The examination of a single sural nerve achieved a sensitivity of 83.3% and a specificity of 97.2% in diagnosing DPN. Multivariate logistic regression analysis identified HbA1c level as the only significant predictor of DPN. Comparison of sural nerve responses between non-neuropathic T1DM patients and the control group indicated pre-electrophysiological nerve abnormalities within the T1DM cohort.

Conclusions

Evaluation of a single sural nerve response in pediatric T1DM patients can replace conventional nerve studies. The study supports the use of point-of-care devices for DPN detection, potentially simplifying and enhancing clinical practice.