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Objective: In vivo corneal confocal microscopy (CCM) is a novel, rapid, and non-invasive technique that identifies early small fiber damage and can predict the progression and development of clinical neuropathy in adults with type 1 diabetes. However, its usefulness in children is not well established. This study compared corneal confocal microscopy with neuropathic symptoms, signs, and objective measures of neuropathy for the diagnosis of diabetic neuropathy in children with type 1 diabetes., Research Design and Methods: A total of 83 children with type 1 diabetes and 83 healthy participants of similar age underwent assessment of neuropathy symptoms, signs, nerve conduction studies, quantitative sensory and autonomic function testing, and in vivo CCM., Results: Only of 3/83 (4%) children with type 1 diabetes had subclinical neuropathy. However, corneal nerve fiber density (p = 0.001), branch density (p = 0.006), fiber length (p = 0.002), tibial motor nerve amplitude and conduction velocity, and sural sensory nerve amplitude and conduction velocity (all p < 0.004) were lower in participants with type 1 diabetes than in the controls. Vibration, cooling, and warm perception thresholds and deep breathing heart rate variability were not found to be different (all p > 0.05) between children with type 1 diabetes and healthy controls. Multivariate regression analysis identified a possible association between body mass index and decreased corneal nerves., Conclusions: Decreased corneal nerves and abnormal nerve conduction were found in children with type 1 diabetes. CCM may allow rapid objective detection of subclinical diabetic neuropathy in children and adolescents with type 1 diabetes., (© 2022 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: Neuropathy is an important complication and contributes to the morbidity of diabetes mellitus. The availability of simple and non-invasive tests for screening of early diabetic neuropathy (DN) in children with diabetes may prevent further progression of this complication. The purpose of this study was to compare conventional nerve conduction studies (NCS) with non-invasive techniques, including vibration perception thresholds (VPT) and tactile perception thresholds (TPT) for the detection of DN in children and adolescents with type 1 diabetes., Methods: Children from the Alberta Children's Hospital Diabetes Clinic with at least 5 yr duration of type 1 diabetes underwent detailed evaluations, including neurologic exam, NCS, VPT, and TPT testing. Information on duration of diabetes, height, and mean glycosylated hemoglobin (A1C) were also collected. Descriptive statistics, including Student's t-test and chi-squared test, were used for analysis., Results: Seventy-three children (mean age of 13.7+/-2.6 yr) completed the study. The mean duration of diabetes was 8.1+/-2.6 yr, and the mean A1C was 9.0+/-1.0%. Forty-two (57%) children had DN based on NCS. Using NCS as a gold standard, the sensitivity and specificity of VPT were 62 and 65%, while the sensitivity and specificity of TPT were 19 and 64%, respectively., Conclusions: Subclinical DN is common among children and adolescents with type 1 diabetes, and there is a need for better metabolic control in this population. VPT and TPT may not be adequate screening tools for the detection of DN in children.