Screening practices for diabetic peripheral neuropathy in pediatric type 1 diabetes: a nationwide survey by the ISPED Diabetes Study Group

Aims: Diabetic peripheral neuropathy (DN) is a major complication of type 1 diabetes (T1D), frequently subclinical in youth. Although international pediatric guidelines recommend annual screening, adherence in pediatric care is uncertain. This study aimed to assess DN screening practices in Italian pediatric diabetes centers and identify barriers to implementation. Methods: Between December 2024 and May 2025, we conducted a nationwide, cross-sectional survey among Italian centers affiliated with the ISPED Diabetes Study Group. One respondent per center completed a 27-item questionnaire exploring organizational features, DN screening practices, and professional training. Results: Forty-eight centers responded to the survey. Written internal protocols for DN screening were available in 22.9% of centers. Only 18.6% reported annual screening, while more than 40% initiated screening only in the presence of symptoms. Recommended criteria (age ≥ 11 years and 2-5 years diabetes duration) were applied by 31.3% of centers. Clinical neurological examination was widely adopted (95.8%), whereas nerve conduction studies (29.2%) and the Michigan Neuropathy Screening Instrument (14.6%) were rarely used. Notably, 89.6% of respondents had never received formal training in DN screening. Centers where pediatric diabetologists personally conducted the assessment were more likely to adhere to annual screening (p = 0.010). Conclusions: Screening for DN in Italian pediatric diabetology is inconsistent and frequently delayed, contributing to probable underrecognition of early neuropathic changes. Strengthening professional awareness, promoting structured training, and implementing harmonized national protocols are essential steps to ensure timely identification and equitable care for children and adolescents with T1D.