Does This Patient With Diabetes Have Large-Fiber Peripheral Neuropathy?

Kanji, Jamil N.; Anglin, Rebecca; Hunt, Dereck; Panju, Akbar

doi:10.1001/jama.2010.428

Cited by 76 publications

(49 citation statements)

References 36 publications

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“…The nerve conduction study is a reliable and objective diagnostic method to evaluate the diabetic polyneuropathy treatment response [26]. Although a nerve conduction study is regarded as the gold standard in clinical research, it is not useful in clinical practice because it is time-consuming, requires special devices and trained examiners, and has no general consensus regarding its criteria, even after multiple investigations [27].…”

Section: Introductionmentioning

confidence: 99%

Dynamic Properties of Skeletal Muscle Contraction in Rats with Diabetes

Beregova¹,

Nozdrenko²,

SergiiBerehovyi³

et al. 2018

Pathophysiology - Altered Physiological States

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The study was conducted on 20 white nonlinear male rats, which were divided into 2 groups of 10 animals each. Rats in the first group were used as control. Rats in the second group were induced type I diabetes by intraperitoneal (i.p.) administration of streptozotocin (65 mg/kg). Diabetes in rats was confirmed by the presence of hyperglycemia. For the establishment of nociceptive pain sensation, mechanical nociceptive test and tail-flick test were conducted in rats. Further animals were anesthetized by i.p. administration of Nembutal (40 mg/kg). The study of dynamic properties of muscle contraction was performed under conditions of the tibia muscle activation by using the modulated stimulation of efferent n. tibialis. Streptozotocin (STZ) was injected in rats; as a result, the blood glucose level was increased by 4.4 times (p ≤ 0.001). Pain sensitivity in diabetic rats was suppressed, indicating the development of peripheral neuropathy. In rats with diabetes, biomechanical parameters of tibia muscle contraction such as the maximum force of contraction, the speed of maximum force of contraction, the retention time of maximum force of contraction and integrated power of muscle contraction (it is calculated on the total area of the received force curves) were violated. This prevents adequate implementation motor neuron pools muscular system, which will have significant consequences in accurate positional movements.

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Section: Introductionmentioning

confidence: 99%

Dynamic Properties of Skeletal Muscle Contraction in Rats with Diabetes

Beregova¹,

Nozdrenko²,

SergiiBerehovyi³

et al. 2018

Pathophysiology - Altered Physiological States

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show abstract

“…It is very reliable, because it encompasses the examination of several modalities and enables a global assessment of neuropathy inasmuch as it permits examination of both large-fiber (ankle reflexes and vibration perception) and small-fiber (pin-prick and temperature sensation) function (12). This contrasts with other diagnostic tests, such as nerve conduction study and skin biopsy, which only examine large- and small-fiber function, respectively (13,14). Of additional significance, NDS has been documented as a reliable strong predictor of the future risk for foot ulceration (1,15).…”

Section: Methodsmentioning

confidence: 92%

Accuracy of the Neuropad Test for the Diagnosis of Distal Symmetric Polyneuropathy in Type 2 Diabetes

et al. 2011

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OBJECTIVETo estimate the accuracy of Neuropad for the diagnosis and staging of distal symmetric polyneuropathy (DPN) across different stages of neuropathy, using multiple-level likelihood ratios (LRs) to interpret the time necessary to complete the color change of the test.RESEARCH DESIGN AND METHODSWe conducted a cross-sectional, cohort-type diagnostic accuracy study in 251 consecutive adult type 2 diabetic patients with no peripheral arterial disease or other potential causes of neuropathy, who were recruited between January 2005 and December 2008 from the diabetes outpatient clinics in Alexandroupolis Hospital, Greece. Patients were tested for DPN by means of the neuropathy disability score (NDS) and Neuropad. Multiple-level LRs for time to complete color change were calculated across different stages of neuropathy.RESULTSThe areas under the curve for the diagnosis of any (NDS of ≥3), at least moderate (NDS of ≥6), or severe (NDS of ≥9) DPN were 0.91, 0.96, and 0.97, respectively. The calculation of multiple-level LRs showed that time to complete color change <360 s suggested the absence of neuropathy. Values between 360 and 1,000 s were indicative of mild neuropathy. Finally, values between 1,000 and 1,200 or >1,200 s were strongly suggestive of moderate or severe DPN, respectively.CONCLUSIONSNeuropad could be used as a triage test for the diagnosis and staging of DPN in patients with type 2 diabetes, prompting referral to specialized care setting.

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“…31 In the presence of thick fiber involvement, which occurs commonly in diabetic neuropathy, there is loss of plantar protective sensitivity and its early detection through the use of Semmes-Weinstein monofilament and the 128 Hz Tuning Fork Test allows for preventive measures that prevent progression to foot ulceration. 32 The use of Semmes-Weinstein (SW) monofilaments, according to several prospective studies, demonstrates that in the absence of pressure sensation with 10g monofilament, there is a high prediction for subsequent ulceration. 24 The technique recommended by the International Working Group on Diabetic Foot (IWGDF), adapted by the Brazilian Society of Diabetes, will be adopted, which recommends testing at 4 points instead of 3.…”

Section: Discussionmentioning

confidence: 99%

Ficha de avaliação clínica de membros inferiores para prevenção do pé diabético Clinical evaluation form of lower members for diabetic foot prevention

Mello

Pires

Kede

2017

R. pesq. cuid. fundam. online

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Objective: To elaborate a clinical evaluation sheet (CES) of the lower limbs (LL) for diabetic foot (DF) prevention. Methods: Based on literature review, a four-phased CES has been elaborated: phases 1 and 2 contemplate clinical evaluation (anamnesis and physical evaluation, respectively) with emphasis on feet evaluation and search for soreness risk factors; phase 3 evaluates feet care and phase 4 describes the main guidelines for this care. Results: With the completion of phases 1 and 2, a feet soreness risk rating follows. Phase 3 evaluates feet care with ten questions and phase 4 presents ten educational guidelines for DF prevention. Conclusion: The proposed CES enables the detection and early intervention on foot soreness risk. Descriptors RESUMENObjetivo: Desarrollar formulario de evaluación clínica (FEC) de los miembros inferiores (MIs) para la prevención del pie diabético (PD). Métodos: A partir de la revisión de la literatura, fue preparada una FEC con 4 fases: fases 1 y 2 incluyen examen clínico (anamnesis y la exploración física, respectivamente), con énfasis en la evaluación de los pies y los factores de riesgo para buscar úlceras; fase 3 se evalúa el autocuidado con sus pies y la fase 4 se describen las pautas principales para este tipo de atención. Resultados: Después de la terminación de las fases 1 y 2 sigue la clasificación de riesgo de la ulceración de los pies. Fase 3 evalúa con diez preguntas del cuidado de los pies y la fase 4 presenta diez directrices educativas para prevenir el PD. Conclusión: La propuesta FEC permite detectar e intervenir temprano en riesgo de ulceración de los pies.

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Does This Patient With Diabetes Have Large-Fiber Peripheral Neuropathy?

Abstract: Physical examination is most useful in evaluating for LFPN in patients with diabetes. Abnormal results on monofilament testing and vibratory perception (alone or in combination with the appearance of the feet, ulceration, and ankle reflexes) are the most helpful signs.

Cited by 76 publications

References 36 publications

Dynamic Properties of Skeletal Muscle Contraction in Rats with Diabetes

Dynamic Properties of Skeletal Muscle Contraction in Rats with Diabetes

Accuracy of the Neuropad Test for the Diagnosis of Distal Symmetric Polyneuropathy in Type 2 Diabetes

Ficha de avaliação clínica de membros inferiores para prevenção do pé diabético Clinical evaluation form of lower members for diabetic foot prevention

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