ارزیابی نوروپاتی دیابتی با استفاده از نوار عصب در کودکان و نوجوانان مبتلا به دیابت نوع 1

سابقه و هدف: نوروپاتی دیابتی (dn) یکی از شایع‌ترین عوارض دیابت است که می‌تواند منجر به ناتوانی و مرگ و میر شود. تقریبا نیمی از بیماران دیابتی به dn مبتلا خواهند شد. مطالعات اندکی به منظور ارزیابی شیوع dn در کودکان انجام شده است. بیش از 90 درصد کودکان دیابتی به دیابت نوع 1 (t1dm) مبتلا هستند. دقیق ترین راه تشخیص نوروپاتی، نوار عصب (ncv) است. بر این اساس، هدف از این مطالعه بررسی شیوع dn در کودکان مبتلا به t1dm، توسط علائم بالینی، معاینات نورولوژیک و ncv بود.مواد و روش‌ها: این مطالعه، یک مطالعه مقطعی است که بین سال‌های 1400 تا 1402 انجام شد. بیماران (کم‌تر از 18 سال) مبتلا به t1dm که حداقل 5 سال از تشخیص بیماری آن‌ها گذشته بود و از سایر بیماری‌ها مانند کم کاری تیروئید و بیماری‌های عصبی عضلانی رنج نمی‌بردند، وارد مطالعه شدند. کودکانی که مایل به انجام ncv نبودند، از مطالعه حذف شدند. اطلاعات دموگرافیک بیماران (سن، جنس، وزن، قد، شاخص توده بدنی (bmi) و مدت ابتلا به دیابت) جمع‌آوری شد. علائم عصبی با استفاده از نمره علائم نوروپاتی (nss) ارزیابی شد. از بیماران در مورد گزگز، سوزش، بی‌حسی، خستگی، گرفتگی و درد در اندام تحتانی سوال شد. سابقه بالینی بیماران شامل hba1c، فشار خون، رتینوپاتی، لیپودیستروفی، نفروپاتی، سابقه کتواسیدوز دیابتی و دوز روزانه انسولین مورد بررسی قرارگرفت. رفلکس آشیل، با استفاده از چکش رفلکس و عملکرد اعصاب محیطی از طریق مونوفیلامان 10 گرمی ارزیابی شد. بیمارانی که معیارهای ورود به مطالعه را داشتند، ncv برای آن‌ها انجام شد. ncv توسط متخصص طب فیزیکی و توانبخشی انجام شد. در ncv، اعصاب حسی و حرکتی پرونئال، تیبیال، و سورال در هر دو اندام تحتانی و اعصاب حسی و حرکتی مدیان و اولنار در هر دو اندام فوقانی مورد بررسی قرار گرفت.یافته‌ها: در پژوهش حاضر، 32 بیمار مبتلا به t1dm، معیارهای لازم برای ورود به مطالعه را داشتند. میانگین سن2/55 ±14/16 سال)، قد (8/96±154/28 سانتی‌متر)، وزن (12/32±±44/88 کیلوگرم) و bmi (3/787±±18/55) بیماران مورد ارزیابی قرار گرفت. میانگین مدت زمان ابتلا به دیابت در بیماران مورد بررسی، 2/428±7/1 سال بود. میانگین میزان hba1c، 1/941±±9/54 درصد بود. میانگین nss، 2/62±2/94 بود. نتایج nss نشان داد که 75/18درصد (امتیاز: 3 یا 4)، 25/31 درصد ±(امتیاز: 5 یا 6)، و 6/25 درصد از بیماران به ترتیب علائم خفیف، متوسط و شدید (امتیاز: 7 تا 9) داشتند. فشار خون بیماران مورد بررسی در محدوده نرمال قرار داشت. لیپودیستروفی (21/87 درصد)، نفروپاتی (12/5 درصد) و رتینوپاتی (3/12 درصد) به ترتیب از شایع‌ترین عوارض دیابت نوع 1 در بیماران بودند. نتایج ارزیابی رفلکس آشیل نشان داد که هیچ اختلالی در هیچ یک از بیماران وجود ندارد. تنها یکی (3/12 درصد) از بیماران مورد بررسی در ارزیابی توسط مونوفیلامان، مبتلا به اختلال اعصاب محیطی تشخیص داده شد. با این حال، نتایج ncv این بیمار نشان داد که بیمار نوروپاتی محیطی ندارد.استنتاج: نتایج مطالعه حاضر نشان داد که شیوع dn در کودکان و نوجوانان مبتلا به t1dm بسیار کم است. نتایج مطالعه حاضر همانند سایر مطالعات مشابه، نشان داد که ارزیابی بالینی صرف و داشتن علائم dn، به اندازه کافی برای تشخیص dn حساس نیست. بنابراین، ارزیابی بیش‌تر از طریق آزمون استاندارد(ncv) در این زمینه موردنیاز است. براساس نتایج مطالعه حاضر، ncv برای بیماران t1dm زیر 18 سال که نتایج مونوفیلامان 10 گرمی آن‌ها نیز منفی بود، پیشنهاد نمی‌شود. تعداد محدودی از بیماران در مطالعه حاضر مورد ارزیابی قرار گرفتند و انجام مطالعات با جمعیت بیش‌تر ضروری است.

evaluation of diabetic neuropathy using nerve conduction velocity in children and adolescents with type 1 diabetes

background and purpose: diabetic neuropathy (dn) is one of the most common complications of diabetes which causes disability and mortality. nearly half of patients with diabetes develop dn. a few studies have been conducted to evaluate the prevalence of dn in children. more than 90% of diabetic children have type 1 diabetes mellitus (t1dm). the most accurate way to diagnose neuropathy is ncv. accordingly, the present study investigates the prevalence of dn in children with t1dm by clinical symptoms, neurological examinations, and ncv.materials and methods: this cross sectional study was conducted between 2021 and 2023 after approval. patients (younger than 18 years old) with t1dm, diagnosed for at least 5 years, and not suffering from other diseases such as hypothyroidism and neuromuscular diseases were included. children who were not willing to undergo ncv were excluded from the study. demographic data of patients (age, gender, weight, height, body mass index (bmi), and duration of diabetes) were collected. neurological symptoms were evaluated using the neuropathy symptom score (nss). patients were asked about tingling, burning, numbness, fatigue, cramping, and pain in the lower extremities. the clinical history of the patients, including hba1c levels, blood pressure, retinopathy, lipodystrophy, nephropathy, history of diabetic ketoacidosis, and daily insulin dosage, was evaluated. the achilles reflex was evaluated using the case reflex hammer and peripheral nerve function through 10g monofilament in patients. patients who met the inclusion criteria of the study underwent ncv. ncv was performed by a specialist in physical medicine and rehabilitation. in ncv, peroneal, tibial, and sural sensory and motor nerves were performed in both lower limbs, and median and ulnar sensory and motor nerves in both upper limbs.results: in the present study, 32 patients with t1dm met the study criteria. the mean age was (14.16±2.55 years), height (154.28±8.96 cm), weight (44.88±12.32 kg), and bmi (18.55±3.787) of the patients. the mean duration of diabetes in the studied patients was 7.1±2.428 years. the mean hba1c was 9.54%±1.941. the mean nss was 2.94±2.862. the nss results showed that 18.75% (score: 3 or 4), 31.25% (score: 5 or 6), and 6.25% of patients had mild, moderate, and severe symptoms (score: 7 to 9), respectively. the blood pressure of the examined patients was in the normal range. the most common complications of type 1 diabetes mellitus in patients were lipodystrophy (21.87%), nephropathy (12.5%), and retinopathy (3.12%). the results of achilles reflex evaluation revealed no disorder in any of the patients. only one (3.12%) of the studied patients was diagnosed with peripheral nerve disorder in the evaluation by monofilament. however, the ncv results of this patient showed that the patient did not have peripheral neuropathy.conclusion: we found that the prevalence of dn in children and adolescents with t1dm is very low. our results, similar to those of other studies, showed that a mere clinical evaluation and having dn symptoms are not sensitive enough to diagnose dn. further investigation through a standard test (ncv) is needed in this regard. based on the results of the present study, ncv is not recommended for t1dm patients under 18 years of age, whose 10g monofilament results were also negative. a limited number of patients were evaluated in the present study and it is necessary to conduct studies with a larger population.background and purpose: diabetic neuropathy (dn) is one of the most common complications of diabetes which causes disability and mortality. nearly half of patients with diabetes develop dn. a few studies have been conducted to evaluate the prevalence of dn in children. more than 90% of diabetic children have type 1 diabetes mellitus (t1dm). the most accurate way to diagnose neuropathy is ncv. accordingly, the present study investigates the prevalence of dn in children with t1dm by clinical symptoms, neurological examinations, and ncv.materials and methods: this cross sectional study was conducted between 2021 and 2023 after approval. patients (younger than 18 years old) with t1dm, diagnosed for at least 5 years, and not suffering from other diseases such as hypothyroidism and neuromuscular diseases were included. children who were not willing to undergo ncv were excluded from the study. demographic data of patients (age, gender, weight, height, body mass index (bmi), and duration of diabetes) were collected. neurological symptoms were evaluated using the neuropathy symptom score (nss). patients were asked about tingling, burning, numbness, fatigue, cramping, and pain in the lower extremities. the clinical history of the patients, including hba1c levels, blood pressure, retinopathy, lipodystrophy, nephropathy, history of diabetic ketoacidosis, and daily insulin dosage, was evaluated. the achilles reflex was evaluated using the case reflex hammer and peripheral nerve function through 10g monofilament in patients. patients who met the inclusion criteria of the study underwent ncv. ncv was performed by a specialist in physical medicine and rehabilitation. in ncv, peroneal, tibial, and sural sensory and motor nerves were performed in both lower limbs, and median and ulnar sensory and motor nerves in both upper limbs.results: in the present study, 32 patients with t1dm met the study criteria. the mean age was (14.16±2.55 years), height (154.28±8.96 cm), weight (44.88±12.32 kg), and bmi (18.55±3.787) of the patients. the mean duration of diabetes in the studied patients was 7.1±2.428 years. the mean hba1c was 9.54%±1.941. the mean nss was 2.94±2.862. the nss results showed that 18.75% (score: 3 or 4), 31.25% (score: 5 or 6), and 6.25% of patients had mild, moderate, and severe symptoms (score: 7 to 9), respectively. the blood pressure of the examined patients was in the normal range. the most common complications of type 1 diabetes mellitus in patients were lipodystrophy (21.87%), nephropathy (12.5%), and retinopathy (3.12%). the results of achilles reflex evaluation revealed no disorder in any of the patients. only one (3.12%) of the studied patients was diagnosed with peripheral nerve disorder in the evaluation by monofilament. however, the ncv results of this patient showed that the patient did not have peripheral neuropathy.conclusion: we found that the prevalence of dn in children and adolescents with t1dm is very low. our results, similar to those of other studies, showed that a mere clinical evaluation and having dn symptoms are not sensitive enough to diagnose dn. further investigation through a standard test (ncv) is needed in this regard. based on the results of the present study, ncv is not recommended for t1dm patients under 18 years of age, whose 10g monofilament results were also negative. a limited number of patients were evaluated in the present study and it is necessary to conduct studies with a larger population.