Diabetic foot in children and adolescents: The next epidemic? A meta-analysis

Aim. Recent estimates of the International Diabetes Federation indicate that 8.3% of adults - 382 million people - have diabetes mellitus (DM), one in two people with diabetes have no awareness of their own disease and the number of people with the DM is set to rise beyond 592 million in 2020. An increased prevalence of type 2 DM (T2DM) in children has been reported worldwide. Foot disorders result in major long-term complications for diabetic patients. Increased risks for lower limb amputation in adults have been associated with peripheral neuropathy with loss of protective sensation, peripheral vascular disease, altered biomechanics. There are few reports concerning foot problems in any pediatric cohort. The aim of this meta-analysis was to review the current literature on foot problems in children and adolescents with DM. Methods. A systematic review was performed on all articles published from January 1980 to August 2014 and listed in MEDLINE, EMBASE, CENTRAL, and in hand-searched reference lists from all identified articles. We searched the terms: "foot" AND "pediatric" AND "children" AND "diabetes mellitus". Results. The international guidelines recommend that children with diabetes have their feet examined since puberty and then at least annually for protective sensation, pulses, skin integrity, and treatable nail problems such as ingrown toenails. Some authors have reported that many young patients with DM have foot problems and evidence of early manifestation of peripheral neuropathy in adolescents with T2DM. Conclusion. By t this research we wanted to highlight the importance of foot examination and foot care advice for children and adolescents with diabetes. Larger prospective studies are required to establish prevalence and to optimize preventive interventions.