Prevalence and presentation of lower limb neurovascular complications in children with diabetes: a systematic review with proportion meta-analysis

Introduction: Disorders of the lower limb are common in people with diabetes and may result in significant long-term complications. Currently, most evidence for lower limb complications in children with diabetes relies on infrequent clinical observations and occasionally invasive assessments that can cause discomfort. Clinical guidelines do not provide explicit guidance on frequency of neurovascular assessments for children with diabetes. Aim: To systematically review the prevalence and presentation of clinical neuropathy and vasculopathy in children with diabetes. Methods: A systematic search of the literature was conducted in March 2024 using the EMBASE, Cochrane, PubMed (including MEDLINE) and CINAHL databases. At least two authors independently screened studies for inclusion and assessed methodological quality for each paper using the downs and black quality appraisal checklist. Extracted data was summarised and tabulated. Meta-analysis was also performed. Results: Eighteen studies with 3533 participants were included. Participants were aged 3.5–18 years, and 95% had type 1 diabetes, while 5% had type 2 diabetes. These studies used a range of assessments, including monofilament, vibrioception, sharp-blunt discrimination, temperature perception, reflexes, muscle strength and tone, joint perception, pedal pulses, and ankle brachial index (ABI). Prevalence of clinical neuropathy ranged from 0% to 57.1% with a prospective cohort study reporting a 2.6-fold increase in 5 years, while prevalence of vascular complications ranged from 0% to 37.8%. The meta-analysis reported 0%–7% of children could report abnormality on assessments for neuropathy. Conclusion: The broad range may be due to heterogeneous methodological designs and diagnostic assessments, and potentially inadequate reporting. There is emerging evidence that children with diabetes may develop complications before age 18, which provides impetus for clinical caution. Higher quality evidence, particularly from longitudinal studies, is required to guide clinical screening for lower limb vascular and neurological complications in this vulnerable and growing paediatric population.