Clinical Tools for Peripheral Neuropathy to Exclude Cardiovascular Autonomic Neuropathy in Type 2 Diabetes Mellitus

Abstract

Introduction: Assessment for cardiovascular autonomic neuropathy (CAN) remains difficult in everyday clinical practice. We sought to examine the diagnostic utility of various simple tools for diabetic peripheral neuropathy (DPN) in the detection of CAN in type 2 diabetes mellitus. Methods: We examined 153 type 2 diabetes mellitus subjects by various DPN tools (vibration perception threshold, 10 g Semmes-Weinstein monofilament, Ipswich touch test, NCstat Ò /DPNCheck, neuropathy disability score) for the detection of CAN. CAN was diagnosed by the standardised cardiovascular autonomic reflex function tests. Results: For the diagnosis of CAN, assessment of small nerve fibre function (pinprick sensation, temperature perception) yielded a very high negative predictive value (97%), with high sensitivity (89%) and moderate specificity (73%). The vibration perception threshold was second in diagnostic utility (91% negative predictive value, 62% sensitivity and 75% specificity). Conclusions: Based on their high negative predictive value, simple tools for DPN may prove useful to exclude CAN in type 2 diabetes mellitus. These encouraging results merit further evaluation to enable wider screening for CAN.

Point‐of‐care sural nerve conduction could predict the presence of cardiovascular autonomic neuropathy in type 1 diabetes mellitus

“…In type 2 diabetes mellitus, Pafili et al 8 . evaluated a variety of simple available DPN tools to define their diagnostic performances for CAN.…”

“…In type 2 diabetes mellitus, Pafili et al . 8 evaluated a variety of simple available DPN tools to define their diagnostic performances for CAN. The assessment of small nerve fiber function (pinprick sensation and temperature perception) yielded a very high NPV (97%), with a sensitivity of 89% and moderate specificity (73%).…”

“…However, these diagnostic methods are somehow subjective and require the full cooperation of patients. In the same study 8 , the authors also analyzed POCD performance in diagnosing CAN, showing a low sensitivity (50%), and moderate specificity (76%). Unlike us, they did not use absolute values of AMP POCD and/or nerve conduction velocities 8 .…”

“…In the same study 8 , the authors also analyzed POCD performance in diagnosing CAN, showing a low sensitivity (50%), and moderate specificity (76%). Unlike us, they did not use absolute values of AMP POCD and/or nerve conduction velocities 8 . The POCD examination was considered abnormal when AMP POCD was <4 μV and/or when CV POCD was <40 m/s in at least one of the two lower extremities.…”

“…In view of these limitations, prior studies have aimed to simplify the diagnosis of CAN [8][9][10] . However, they did not reduce the need for special hardware and qualified staff 4,5 .…”