Pediatric Diabetes 2008: 9: 110–114 doi: 10.1111/j.1399-5448.2007.00339.x All rights reserved # 2008 The Authors Journal compilation # 2008 Blackwell Munksgaard Pediatric Diabetes Original Article Peripheral neuropathy is an early complication of type 2 diabetes in adolescence Karabouta Z, Barnett S, Shield JPH, Ryan FJ, Crowne EC. Peripheral neuropathy is an early complication of type 2 diabetes in adolescence. Pediatric Diabetes 2008: 9: 110–114. Objective: To screen for microvascular complications in adolescents with type 2 diabetes mellitus (T2DM). Subjects and methods: Seven adolescents with T2DM were assessed for early secondary complications. Median duration of diabetes was 1.8 (0.8–3.0) yr. All were assessed as follows: blood pressure, ophthalmologic examination for diabetic retinopathy, renal function, full blood count and vitamin B12 levels (to exclude B12 malabsorption – a side effect of metformin), random urine for microalbuminuria, an electrocardiogram (ECG) rhythm strip and podiatry performed by an experienced podiatrist. Testing for peripheral neuropathy included foot pulse palpation, tendo- Achilles reflexes, plantar callus test, large nerve fibre function (vibration and threshold for light touch/pressure) assessed by a 128-Hz tuning fork, and by the standard 10-g Semmes–Weinstein monofilament test, and small nerve fibre function (pain) assessed by pinprick neurotip. Results: Four adolescents had evidence of peripheral neuropathy on clinical examination, with abnormal large and small nerve fibre function. Six had plantar callus present, and four had weak but palpable posterior tibial pulses. All had normal tendo-Achilles reflex and normal response to vibration. None had diabetic retinopathy or hypertension. Renal function, full blood count (FBC), B12 levels and ECGs were normal. None of 120 adolescents with type 1 diabetes mellitus (T1DM) assessed by the same podiatrist had any signs of peripheral neuropathy. Conclusions: Unlike T1DM, peripheral neuropathy can be present soon after diagnosis in those with T2DM. Children with T2DM need surveillance for complications from the time of diagnosis. Zacharoula Karabouta, Susan Barnett, Julian PH Shield, Fiona J Ryan and Elizabeth C Crowne Department of Paediatric Endocrinology & Diabetes, Directorate of Children’s Services, Bristol Royal Hospital for Children, Bristol, UK Key words: adolescents – peripheral neuropathy – T2DM Corresponding author: Dr Z Karabouta 13 St Matthews Road Cotham Bristol, BS6 5TS UK. Tel: 144 117 900 2350; fax: 144 117 900 2370; e-mail: zkarabouta@yahoo.com Submitted 14 October 2005. Accepted for publication 6 September 2007 Type 2 diabetes mellitus (T2DM) is an emerging problem in childhood. It is more frequently diagnosed in certain ethnic groups, but the prevalence is increa- sing in Caucasians (1–3). Fifteen years ago, T2DM accounted for about 2–3% of all cases of newly diagnosed diabetes in children and adolescents in the USA, whereas today, it is estimated to account for 8–45% of new cases amongst adolescents (4). Con- comitant with a general rise in childhood obesity prevalence, more countries are regularly identifying childhood-onset T2DM (5–7). In adults with T2DM, complications can present early, presumably because of previously unrecognized hyperglycaemia. It is reported that up to 60% of adults will develop some form of neuropathy within 10 yr of diagnosis of T2DM (8). The emergence of T2DM in adolescence has important implications for both the health of the individual and health service resources. Treatment compliance (9) and psychological health (10) are often poor in childhood T2DM. Various studies imply an accelerated risk of nephropathy (11, 12) and retino- pathy (13) compared with young people with type 1 diabetes mellitus (T1DM), while recent data indicate early signs of cardiovascular disease in youth with T2DM (14). The only currently available longitudinal data make for worrying reading; of 79 children recontacted up to 15 yr after the diagnosis of T2DM, 9% had died and 6% were on dialysis (15). We present evidence for early manifestation of peripheral neuropathy in adolescents with T2DM, the 110