Subclinical musculoskeletal, neuropathy and otorhinolaryngologic complications in children with type I DM

Objectives: To evaluate the subclinical MSK manifestations, subclinical sensory peripheral neuropathy and otorhinolaryngologic manifestations in type I diabetic children and correlation of these manifestations with duration and severity of DM. Patients and Methods: This case-control study was carried out in the period from June 2013 to April 2015. The study includes group I (64 children with type I DM) and group II (50 apparently healthy children as controls). All participants were subjected to: 1-complete history taking, 2- complete MSK examination, 3- complete neurological examination, 4- ENT examination (pure tone audiometry, speech audiometry and tympanometry and acoustic reflex), 5- laboratory investigations (RBC, HbA1C, RF, ANA, Anti-DNA, ESR, CRP), 6- MSK US of shoulder joints, 7- electrodiagnostic evaluation of sensory nerve conduction study to sensory branch of median, ulnar and nerves. Results: shoulder US examination revealed tendinitis, bursitis and joint effusion with significant difference between DM group and controls. Positive significant correlation between tendinitis and disease duration, RBS and HbA1C. Also significant positive correlation between bursitis, effusion and disease duration, age, HbA1C, RBS. Electrophysiological examination revealed median, ulnar and sural neuropathy with significant difference between DM group and controls. Positive correlation between RT. Median, sural neuropathy and disease duration while between RT. Ulnar neuropathy and RBS. 20% of DM group have mild SNHL, 20% of them have Eustachian dysfunction with no significant difference with controls. Conclusion: subclinical MSK, sensory peripheral neuropathy and otorhinolaryngologic complications are associated with children type 1 DM and correlated with disease duration and severity. MSK US and audiometry should be included in type I DM children clinical examination.