The DNS is validated, fast and easy to perform, with a high predictive value when screening for diabetic polyneuropathy.

A hierarchical scoring system to diagnose distal polyneuropathy in diabetes OBJECTIVE -Existing physical examination scoring systems for distal diabetic polyneuropathy (PNP) do not fulfill all of the following criteria: validity, manageability, predictive value, and hierarchy. The aim of this study was to adapt the Neuropathy Disability Score (NDS) to diagnose PNP in diabetes so that it fulfills these criteria.RESEARCH DESIGN AND METHODS -A total of 73 patients with diabetes were examined with the NDS. Monofilaments and biothesiometry were used as clinical standards for PNP to modify the NDS.RESULTS -A total of 43 men and 30 women were studied; mean duration of diabetes was 15 years (1-43), and mean age was 57 years (19-90). A total of 24 patients had type 1 diabetes, and 49 patients had type 2 diabetes. Clinically relevant items were selected from the original 35 NDS items (specific item scored positive in Ͼ3 patients). The resulting 8-item Diabetic Neuropathy Examination (DNE) score could accurately predict the results of the clinical standards and is strongly hierarchical (H value 0.53). The sensitivity and specificity of the DNE at a cutoff level of 3 to 4 were 0.96 and 0.51 for abnormal monofilament scores, respectively. For abnormal vibration perception threshold scores, these values were 0.97 and 0.59, respectively. Reproducibility as assessed by inter-and intrarater agreement was good.CONCLUSIONS -The DNE is a sensitive and well-validated hierarchical scoring system that is fast and easy to perform in clinical practice.

OBJECTIVE—Several national and international scoring systems are used to diagnose diabetic polyneuropathy (PNP). The variety in these scores and the lack of data on validity and predictive value has led to a comparison and validation of the scores with clinical standards for PNP to determine the most powerful measurement for screening. RESEARCH DESIGN AND METHODS—Three matched groups were selected: 24 diabetic patients with neuropathic foot ulcers, 24 diabetic patients without PNP or ulcers, and 21 control subjects without diabetes. In all participants the scores from the International Consensus on the Diabetic Foot (ICDF) and the Dutch Nederlandse Diabetes Federatie-Centraal Beleids Orgaan (NDF/CBO) were tested. The Diabetic Neuropathy Symptom score, the Diabetic Neuropathy Examination score, Heart Rate Variability, the Nerve Conduction Sum score, and a San Antonio Consensus sum score were obtained as clinical standards. Reproducibility was tested in a separate study (13 patients). RESULTS—The construct validity and discriminative power of the ICDF and NDF/CBO scores were comparable, although monofilaments (NDF/CBO) scored lower. The predictive value was good for all scores, with the best results being obtained for the tuning fork (NDF/CBO). Reproducibility of the NDF/CBO scores (monofilaments and tuning fork) was high. CONCLUSIONS—The characteristics of the scores of tests recommended by ICDF and NDF/CBO are comparable. The single use of the 128-Hz tuning fork produces results similar to the extended scores of the ICDF and much better than those of monofilaments on validation and for predictive value. For screening we therefore advise the use of the tuning fork alone.

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Foot complications in diabetes can be decreased by preventive measures. The authors evaluated the current diabetic foot screening and prevention programme of the diabetes outpatient clinic of their university hospital, by assessing the presence of risk factors for the development of foot disorders and the preventive measures taken.Fifty (50) diabetic patients not known to have foot complications were selected at random. Risk factors and preventive measures were inventarised with the Coleman riskcategorization system and the Preventive Measures Scale, respectively.Sixty per cent (60%) of the patients were at risk of developing diabetic foot complications. The preventive measures were low in these patients. Patient knowledge was insufficient and behaviour even worse. Basal preventive shoe adaptations were absent in most patients at risk. No relation between risk category and the preventional status was found.Cross-sectional examination at a university outpatient clinic showed serious risk profiles for foot complications, which were not balanced by the application of generally accepted preventive measures. At the outpatient clinic, screening should be optimised.

Presence or history of DFUs has a large impact on physical role, physical functioning and mobility. Physical impairments especially influenced QoL. Probably, QoL can be increased by providing attention that will enhance mobility and by giving advice about adaptations and special equipment.