Overview: Adolescent hyperglycemia and long-term neuropathy risk
New research from the University of Michigan highlights a concerning link: poor blood sugar control during adolescence in individuals with type 1 diabetes (T1D) may elevate the risk of developing peripheral neuropathy as adults. This finding adds to the longstanding evidence that sustained hyperglycemia contributes to the complications of diabetes, and it emphasizes the critical window during teenage years where effective glycemic management can influence lifelong health outcomes.
The study at a glance
The investigation analyzed data from a cohort of children diagnosed with T1D between 1990 and 1992. These participants were part of a larger, 30-year longitudinal study conducted in Australia, designed to understand how early-life factors affect long-term diabetes complications. Researchers tracked HbA1c readings from medical records and assessed microvascular complications through a combination of self-reports, clinical screenings, retinal photographs, and urinary albumin-creatinine testing.
Key findings on glycemic exposure and neuropathy
Among the 30 children originally enrolled (with a mean diagnosis age of about 3 years), follow-up after nearly 30 years revealed that 33% developed neuropathy and 10% developed neuropathy alongside other diabetic complications. Notably, mean HbA1c levels during adolescence averaged 9%, substantially higher than levels in childhood and adulthood, which hovered around 8.2% in both periods. The study also found a significant association between greater deviations from each participant’s childhood HbA1c and increased neuropathy risk (relative risk ratio of 7.8). Importantly, these associations were strongest for neuropathy, rather than retinopathy or nephropathy, suggesting a specific sensitivity of the peripheral nerves to glycemic exposure during adolescence.
Interpretation: Why adolescence matters
The researchers concluded that adolescent hyperglycemia may contribute to a higher likelihood of neuropathic complications later in life, independent of childhood glycemic control. This implies that even teens who begin puberty with relatively controlled diabetes could face elevated neuropathy risk if hyperglycemia recurs during adolescence. The finding underscores the importance of maintaining rigorous glycemic management during these formative years and ensuring a smooth transition to adult diabetes care.
Implications for patients, families, and clinicians
Experts emphasize several practical steps to mitigate long-term risk. First, sustained, age-appropriate diabetes education is crucial so teenagers understand how daily decisions around carbohydrates, insulin dosing, and activity influence blood sugar. Second, healthcare teams should strengthen the adolescent-to-adult care transition, ensuring continuity of monitoring for neuropathy and other complications. This may involve structured transition clinics, shared electronic health records, and proactive communication between pediatric and adult endocrinology services.
ector’s perspective: balancing hope with action
Dr. Eva Feldman, a senior author on the study, notes that supporting teens with T1D to achieve stable glycemic control can reduce future complications. Dr. Kara Mizokami-Stout adds that while vascular risk factors also contribute to neuropathy, maximizing support for younger patients remains essential. The study’s message is clear: BETTER glycemic control during adolescence could meaningfully lower adult neuropathy risk and improve quality of life for people living with T1D.
Takeaway for readers
For patients and families, the message is twofold: prioritize aggressive yet realistic diabetes management during adolescence, and plan for a seamless transition into adult care with ongoing neuropathy screening. While genetic and vascular factors also play a role in diabetes complications, modifiable factors during adolescence offer a tangible target for reducing long-term risk.
As this line of research evolves, clinicians and researchers are calling for more comprehensive, longitudinal studies to further clarify the mechanisms linking adolescent glycemic exposure to later neuropathy and to identify interventions that can buffer teens against the development of painful, disabling nerve complications.
