1.10.3.0 Neuropathy
Recommendation
13.44 Consider an annual comprehensive foot exam at the start of puberty or at age ≥10 years, whichever is earlier, once the youth has had type 1 diabetes for 5 years. B
Diabetic neuropathy rarely occurs in prepubertal children or after only 1–2 years of diabetes (116), although data suggest a prevalence of distal peripheral neuropathy of 7% in 1,734 youth with type 1 diabetes and associated with the presence of CVD risk factors (117,118). A comprehensive foot exam, including inspection, palpation of dorsalis pedis and posterior tibial pulses, and determination of proprioception, vibration, and monofilament sensation, should be performed annually along with an assessment of symptoms of neuropathic pain (118). Foot inspection can be performed at each visit to educate youth regarding the importance of foot care (see Section 11 “Microvascular Complications and Foot Care”).