This project is a collaboration between the Centre for Digital Health Interventions and the Children’s Hospital of Eastern Switzerland (OKS).

Diabetic peripheral neuropathies (DPN) are a group of conditions and are the main complication of diabetes. They are the result of damage to the nervous system and are often categorized by which nerves are affected. Symptoms can include tingling, numbness, pain, or reduced reflexes.¹ Many children with Type 1 Diabetes do not experience these symptoms yet. However, various studies, including one previously conducted at the OKS, show a significant reduction in nerve conduction velocity (NCV), the gold standard in the diagnosis and monitoring of nerve damage, compared to healthy children. Unfortunately, there is no cure for DPN, and treatment is limited to supplements and pain management. This makes the prevention of DPN crucial.

A team of PD Dr. med. Philip Broser, Dr. med. Sarah Oberhauser and colleagues have previously developed the St. Galler Method which assesses the NCV of four nerves (peroneal, tibial, median sensory & motor nerves) to cover both sensory and motor nerves. A previous publication by Oberhauser et al. showed a significant correlation between the reduction in NCV and the standard deviation (SD) of the glucose concentration as measured by a continuous glucose monitor (CGM). Other widely used glucose metrics, including HbA1C and average glucose concentrations, also correlate with the reduction in NVC, however less so than the SD. This highlights the importance of glucose fluctuations for the effective prevention of DPN.²

Expanding on the previous work by the OKS, this project aims to further the understanding of the physiological interplay between glucose fluctuation and nerve vitality, incorporate additional lifestyle factors as covariants, and develop preventative measures:

• Identify, benchmark, and develop novel digital biomarkers that capture short-term glycemic fluctuations and deepen the understanding of the influence of glucose fluctuations on the vitality of the peripheral nervous system.
• Systematically track various lifestyle factors, including physical activity and nutrition, and incorporate them into the analyses to investigate their potential to slow down or even reverse the reduction in NCV.
• Build interventions that leverage the previously gained insights to help children and adolescents prevent DPN.

For this project, we are taking a systems-first approach. We are not only answering current research questions but also developing a modular system that allows us to collect longitudinal data from different sources (CGM, wearable, clinical lab data), allowing us to quickly iterate on ideas and test new hypotheses.

The system currently supports the upload, storing, pre-processing, and analysis of CGM data from various CGM manufacturers and software publishers (Medtronic CareLink, Dexcom Clarity, Abbott LibreView, and Glooko), clinical lab data like HbA1C and C-Peptide tests, nerve conduction study data, and sonography data.

[1] Rodica Pop-Busui, Andrew J.M. Boulton, Eva L. Feldman, Vera Bril, Roy Freeman, Rayaz A. Malik, Jay M. Sosenko, Dan Ziegler; Diabetic Neuropathy: A Position Statement by the American Diabetes Association. Diabetes Care 1 January 2017; 40 (1): 136–154. https://doi.org/10.2337/dc16-2042

[2] Oberhauser SS, l’Allemand D, Willems EP, Gozzi T, Heldt K, Eilers M, Stasinaki A, Lütschg J, Broser PJ. Slowing of Peripheral Nerve Conduction Velocity in Children and Adolescents With Type 1 Diabetes Is Predicted by Glucose Fluctuations. Diabetes. 2023 Dec 1;72(12):1835-1840. doi: 10.2337/db23-0063. PMID: 37699386; PMCID: PMC10658059.

Diabetic peripheral neuropathy is one of the most common long-term complications of diabetes. This project aims to investigate it’s causes and develop novel digital monitor biomarkers to assess the progression.

Marc-Robin Gruener, Dr. Mia Jovanova & Prof. Dr. Tobias Kowatsch

October 2023 – May 2024

PD Dr. med. Philip Broser & Dr. Erin West
Ostschweizer Kinderspital

Prof. Dr. Dagmar L’Allemand
Dr. med. Sarah Oberhauser
Dr. med. Katrin Heldt
Dr. med. Miriam Eilers
Sandro Meier
Jürg Lütschg

Initial funding provided by the Ostschweizer Kinderspital (additional grant submissions are currently being reviewed).