الفهرس 
Diabetes Mellitus Type1 in childrenOnly 14 pages are availabe for public view
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Abstract
Childhood diabetes has many forms: The most common forms of diabetes are, Type 1 and Type 2 diabetes mellitus, also rare conditions, such as, neonatal diabetes, chronic disease associated (e.g. with cystic fibrosis) and monogenic diabetes (e.g. maturity onset diabetes of the young). Insulindependent diabetes mellitus (IDDM), type 1 diabetes (T1DM), is a classic example of a T cell-mediated autoimmune disease characterized by selective destruction of pancreatic β cells leads to increased blood sugar levels.
Though evident diabetic neuropathy is seldom present in diabetic children and adolescents, about 25% of pediatric patients with 5years or more diabetes have abnormal findings on nerve conduction studies. Clinical assessment of diabetic neuropathy is not sensitive enough to diagnose diabetic peripheral neuropathy DPN and nerve conduction study is the gold standard for the assessment of DPN .
The main aim of this study was to assess risk of developing peripheral neuropathy in Egyptian children and adolescents with T1DM using nerve conduction and plasma biomarkers including Neuron specific enlase and Heat shock protein27.
A Cross sectional study was conducted on 100 of children aged 818year-old of both sexes; recruited from Pediatric Endocrinology clinic, and Menoufia University Hospital from July 2022 until June 2023 after obtaining Institutional ethical committee approval.
The main results of the study revealed that:
There was statistically significant difference between cases and controls as regard consanguinity. There was no statistically significant difference between them as regard sex and age.
28% of the studied patients group had family history of type 1 DM. The mean age of onset was 6.42 ±2.88 years. The mean diseases duration was 7.28 ±1.77 years. The mean frequency of DKA Admission throughout disease period was 4.28 ±1.26. 10% had complications rather than peripheral neuropathy. 62% of them were normal BMI.
There was no statistically significant difference between cases and controls as regard weight, height, BMI, systolic and diastolic blood pressure.
There was a highly statistically significant difference between cases and controls as regard cholesterol, triglycerides, LDL and HbA1c.
There was a highly statistically significant difference between cases and controls as regard NSE and HSP27.
Regarding neurological assessment among patients group; 12% had decreased light touch and cold and warm perception. 8% had decreases pain sensation. 40% had decreased vibration. 100% had normal tone. 10% had hyporeflexia. 100% had normal power.
Regarding Michigan score; the mean history of Michigan score was 4.54 ±1.03. The median physical assessment was 0.5 (0-1).
According to Dyck classification; 76% didn’t have neuropathy, 16% had subjective subclinical neuropathy and 8% had objective subclinical neuropathy.
There was highly statistically significant difference between peripheral neuropathy and non-peripheral neuropathy group as regard median nerve & tibial and sural nerve conduction velocity and common peroneal and sural nerve latency.
There was statistically significant difference between peripheral neuropathy and non-peripheral neuropathy group as regard age, age of onset, disease duration, frequency of DKA Admission throughout disease period, complications rather than PN, cholesterol, triglycerides, LDL and HbA1c.
There was statistically significant difference between peripheral neuropathy and non-peripheral neuropathy group as regard NSE and HSP27.
There was a statistically significant difference between peripheral neuropathy (n, 12, 24%) and non-peripheral neuropathy (n, 38, 76%) group as regard history and physical assessment of Michigan score.
There was a positive significant correlation between NSE and age, duration of DM, HbA1C and HSP27.
There was a positive significant correlation between NSE and Michigian score of physical assessment, common peroneal nerve and sural nerve latency but there was a negative significant correlation between NSE and conduction velocity of median, tibial, and sural nerve and amplitude and latency of sural nerve.
There was a positive significant correlation between HSP27 age, duration of DM, HbA1C and NSE and there was a statistically significant difference between those had complications rather than peripheral neuropathy and those hadn’t as regard HSP27.
There was a positive significant correlation between HSP 27 and Michigian score of physical assessment but there was a negative significant correlation between NSE and tibial nerve conduction velocity and amplitude of sural nerve.
At cut off point 4.5 the sensitivity and specificity of Michigan score of history in diagnosis of peripheral neuropathy was 75% and 63% respectively. At cut off point 0.75 the sensitivity and specificity of
Michigan score of physical assessment in diagnosis of peripheral neuropathy was 100% and 71% respectively. At cut off point 5.25 the sensitivity and specificity of total Michigan score in diagnosis of peripheral neuropathy was 75% and 71% respectively.