Investigating how diabetic nerve pain can be caught earlier in younger people

Why are Breakthrough T1D funding this research?

Diabetic peripheral neuropathy (DPN) affects many people of all ages with T1D. Teens and young adults are often overlooked in this area as DPN tends to affect older people. However, research suggests that up to 25% of young adults can suffer from DPN. In younger people, symptoms can present differently, which means they can be missed or not fully recognised in clinical care.

Gordon said:

DPN is a common but often overlooked complication of type 1 diabetes, causing nerve damage that can lead to pain, numbness, and long-term foot problems. While DPN is well studied in older adults, much less is known about how and when it develops in adolescents and young adults. Many are assumed to be at low risk, yet emerging evidence suggests early nerve damage may be more common than previously thought.

What is neuropathy?

DPN is a serious and common complication of T1D, with up to 30% of people with T1D experiencing pain in their lifetimes (Lynn Ang et al, Journal of Diabetes and its Complications, 2021). It happens when high glucose levels in the blood damage nerves in your body. This can remove sensation in your outer or ‘peripheral’ areas, such as the feet and legs. This nerve damage can cause ulcers on your feet, which then become hard to heal and can lead to foot or lower leg amputation. DPN is the leading factor in diabetic foot complications. Find out about DPN and other forms of neuropathy that are linked with T1D.  

What will happen during this project?

Gordon and his team will work with teens and young adults who are already registered at Sheffield Teaching Hospital for specialist nerve screening. The participants will undergo a short assessment, including the standard diabetic foot check. The standard test detects DPN at later stages, so Gordon will perform other, specialised tests to assess DPN earlier, and how severe it might be. This includes: 

• Toronto Clinical Scoring System – a commonly used test to see if severe DPN is present 

• A non-invasive test called SUDOSCAN, which tests for small nerve function  

• A hand-held test which will evaluate how well the nerves conduct electricity 

• A questionnaire to identify any pain related to the nerves 

Gordon will then analyse the results to see if these new methods can detect DPN earlier compared to the standard diabetic foot check method.  

How will this project help people with T1D?

DPN is a common complication for people with T1D, but its impact is not well understood in younger people. The current diabetic foot check can only show DPN once it is already present and sensation is lost. With earlier identification and diagnosis, before sensation is lost, there may be an opportunity for intervention. This could help to slow down the nerve damage and reduce pain for people with T1D.

Gordon said: 

“The small grant funded by Breakthrough T1D is essential in enabling this work. It supports participant follow-up, specialist nerve assessments, and data analysis that would not be possible through routine clinical care alone. The findings will help build a clearer picture of early nerve damage in young people with diabetes and provide the foundation for larger, long-term studies aimed at improving outcomes”