A Comparative study of examination scores and quantitative sensory testing in diagnosis of diabetic polyneuropathy

Abstract

Context:Many advances have taken place in the detection of diabetic polyneuropathy with respect to examination scores, electrophysiological techniques and quantitative sensory testing.Aim:This study aims to evaluate the discriminative power of the Diabetic Neuropathy Examination Score (DNE), 10-g Semmes-Weinstein Monofilament Examination (SWME) and Quantitative Sensory Testing by Vibration Perception Threshold (VPT) in the diagnosis of diabetic polyneuropathy and seek an optimal screening method in diabetic clinic.Materials and Methods:Hundred consecutive patients with Type 2 diabetes were subjected to Diabetic Neuropathy Symptom Score, DNE score, Semmes-Weinstein monofilament examination, Vibration Perception Threshold and Nerve Conduction Studies; mean ± SD for the various characteristics were calculated. Sensitivity and specificity for the DNE, SWME and VPT were calculated, taking NCS as gold standard.Results:Seventy one of 100 subjects had evidence of neuropathy confirmed by Nerve Conduction Studies, while 29 did not have neuropathy. The DNE score gave a sensitivity of 83% and a specificity of 79%. The sensitivity of SWME was 98.5% and specificity was 55%. Vibration Perception Thresholds yielded a sensitivity of 86% and a specificity of 76%.Conclusions:A simple neurological examination score is as good as Vibration Perception threshold in evaluation of polyneuropathy in a diabetic clinic. It may be a better screening tool for diagnosis of diabetic polyneuropathy in view of the cost effectiveness and ease of applicability.

Electrophysiological Patterns of Diabetic Polyneuropathy: Experience from a Tertiary Care Hospital of Bangladesh

“…As DPN is related to chronic hyperglycaemia, poorer long-term glycaemic control contributed to worsening neuropathy. 13 The risk of developing DPN has been calculated to rise by approximately 10-15% for every 1% rise in HbA1c. 13 HbA1c levels (but neither fasting nor postprandial glucose levels) showed a strong correlation with changes in motor and sensory NCS parameters: the higher the level, the more pronounced the changes on motor and sensory NCS.…”

“…13 The risk of developing DPN has been calculated to rise by approximately 10-15% for every 1% rise in HbA1c. 13 HbA1c levels (but neither fasting nor postprandial glucose levels) showed a strong correlation with changes in motor and sensory NCS parameters: the higher the level, the more pronounced the changes on motor and sensory NCS. In an earlier study too, no positive correlation between blood glucose levels and alterations in NCS parameters was found.…”

Monochromatic Infrared Photo Energy in Diabetic Peripheral Neuropathy

“…Light touch sensation was assessed with use of the 5.07 SWM [20], which is generally accepted as an effective, inexpensive, portable, painless, easy to administer, and reliable screening method for assessing touch-pressure sensation in a valid fashion. In fact, the SWM was shown to be more sensitive than the vibration perception threshold in measuring peripheral sensation [21,22]. The tester asked blindfolded participants to indicate by stating the word-now when and where on their foot they sensed the pressure of the monofilament.…”

A Comparative Study of Various Bedside Methods in Detection of Diabetic Polyneuropathy in Type 2 Diabetes Patients

“…The study concluded that a simple neurological examination score is as good as VPT in evaluation of polyneuropathy in a diabetic clinic. It may be a better screening tool for diagnosis of diabetic polyneuropathy in view of the cost effectiveness and ease of applicability 10 . The findings were very similar to our study.…”