Neurologic Issues in Children With Type 1 Diabetes Moving to Adult Care

Young woman is measuring blood sugar level and using mobile phone. Gold Coast, Australia.
Children with type 1 diabetes transitioning to adult diabetic care face unique challenges, including whether they have neuropathic lesions at the time of transition. Researchers sought to assess the neuropathic condition of this patient population to better define their needs.

Pediatric patients with type 1 diabetes (T1D) often have peripheral sensory neurologic impairments at the time of their transition to adult diabetes care. These findings were published in Frontiers in Endocrinology.

Patients (N=29) with T1D who were transitioning from the Department of Pediatrics and Pediatric Health Center to the Department of Medicine at the University of Szeged in Hungary between 2019 and 2020 were recruited for this study. Participants were assessed for cardiovascular autonomic functioning, sensory nerve testing, standard laboratory analyses, and by echocardiograph. Results were compared with an age-matched cohort of healthy volunteers (n=30).

Participants with diabetes and controls were aged mean 22.4±2.9 and 21.5±1.6 years, 16 and 18 were women, BMI was 22.8±3.0 and 22.3±3.7 kg/m2, glycated hemoglobin (HbA1c) was 8.5%±2.1% and 5.3%±0.3% (P <.001), diastolic blood pressure was 80±9 vs 74±8 mm Hg (P =.003), and 20.7% and 0.0% had hypertension (P =.011), respectively.

The laboratory analysis found that patients with T1D had significantly higher alkaline phosphatase (P =.003), glucose (P =.010), and estimated glomerular filtration rate (P =.040), and lower albumin (P =.012), magnesium (P =.031), and creatinine (P =.047) compared with controls.

During the peripheral sensory function test, the patients with T1D had impaired vibrational sensing during the 128-Hz Rydel-Seiffer graduated tuning fork test on the right and left radius (both P <.05) and impaired temperature sensitivity during the Tiptherm® test (P <.001). More patients with T1D (n=9) had neuropathic complaints than controls (n=0; P <.01).

Significant correlations were observed between HbA1c and Valsalva ratio (r, -0.483; P =.001) and diastolic blood pressure (r, 0.352; P =.019).

No significant differences were observed between cohorts during echocardiogram or cardiovascular autonomic functional testing.

This study was limited as it remains unclear at what time-point these significant sensory neurologic impairment symptoms manifested during the T1D disease course in these patients. Additional investigation is needed.

“At the time of transition from pediatric to adult-oriented health care in this young TID population, cardiovascular autonomic neuropathy and cardiac morphological differences could not be found,” the study authors said. “However, peripheral sensory neurological impairments with several modalities were detected among young type 1 diabetic patients. The results may provide important feedback to pediatric diabetes care and a remarkable baseline reference point for further follow-up in adult diabetes care.”


Vágvölgyi A, Maróti Á, Szűcs M, et al. Peripheral and autonomic neuropathy status of young patients with type 1 diabetes mellitus at the time of transition from pediatric care to adult-oriented diabetes care. Front Endocrinol. 2021;12:719953. doi:10.3389/fendo.2021.719953