Introduction-Test whether physicians can validly and reproducibly diagnose diabetic sensorimotor polyneuropathy (DSPN).Methods-Twelve physicians assessed 24 patients with diabetes mellitus (DM) on consecutive days (576 examinations) with physical features and voice disguised. Results were compared to gold standard 75% group diagnosis and a nerve conduction score (Σ 5 NC nds).Results-Masking of patients was achieved. Reproducibility measured by the kappa coefficient and compared to Σ 5 NC nd varied considerably among physicians: median and ranges: signs 0.8 (0.32 to 1.0); symptoms 0.79 (0.36 to 1.0) and diagnoses 0.47 (0.33 to 0.84) -both low and high scores indicating poor performance. There was substantial agreement between 75% group dx and confirmed NC abnormality. As compared to Σ 5 NC, individual physicians' clinical diagnosis was excessively variable and frequently inaccurate.Discussion-Study physician diagnosis from signs and symptoms were excessively variable, often over-estimating DSPN. Specific approaches to improving proficiency should be tested.

OBJECTIVETo test whether diabetic polyneuropathies (DPNs), retinopathy, or nephropathy is more prevalent in subjects with impaired glycemia (IG) (abnormality of impaired fasting glucose [IFG], impaired glucose tolerance [IGT], or impaired HbA1c [IA1C]) than in healthy subjects (non-IG).RESEARCH DESIGN AND METHODSMatched IG and non-IG volunteers were randomly identified from population-based diagnostic and laboratory registries, restudied, and reclassified as non-IG (n = 150), IG (n = 174), or new diabetes (n = 218).RESULTSFrequency (%) of DPN in non-IG, IG, and new diabetes was 3 (2.0%), 3 (1.7%), and 17 (7.8%) narrowly defined (no other cause for polyneuropathy) and 19 (12.7%), 22 (12.6%), and 38 (17.4%) broadly defined. Mean and frequency distribution of composite scores of nerve conduction and quantitative sensation tests were not significantly different between IG and non-IG but were worse in new diabetes. Frequency of retinopathy and nephropathy was significantly increased only in new diabetes. In secondary analysis, small but significant increases in retinopathy and nephropathy were found in IGT, IFG, and IGT combined groups.CONCLUSIONSIn population studies of Olmsted County, Minnesota, inhabitants, prevalence of typical DPN, retinopathy, and nephropathy was significantly increased only in subjects with new diabetes—not in subjects with IG as defined by American Diabetes Association (ADA) criteria of abnormality of IFG, IGT, or IA1C. For atypical DPN, such an increase was not observed even in subjects with new diabetes. In medical practice, explanations other than IG should be sought for patients with atypical DPN (chronic idiopathic axonal polyneuropathy) who have IG.

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Introduction Cl. NPhys Trial 3 showed that attributes of nerve conduction (NC) were without significant intra-observer differences but showed significant inter-observer differences. Methods Trial 4 tests whether use of written instructions, pre-trial agreement on techniques, and use of standard reference values, diagnostic percentile values, or broader categorization of abnormality reduces significant inter-observer disagreement and improves agreement among clinical neurophysiologists. Results and Discussion The Trial 4 modifications markedly decreased but did not eliminate significant inter-observer differences of measured attributes of NC. Use of standard reference values and defined percentile values of abnormality decreased inter-observer disagreement and improved agreement of judgment of abnormality among evaluators. Therefore, the same clinical neurophysiologist should perform repeat NCs of therapeutic trial patients. Differences in inter-observer judgment of abnormality decrease with use of common standard reference values and a defined percentile level of abnormality, providing a rationale for their use in therapeutic trials and medical practice.