Low and High Frequency Vibration Perception Thresholds Can Improve the Diagnosis of Diabetic Neuropathy

Abstract

Recent studies demonstrate neuropathic changes with respect to vibration sensitivity for different measurement frequencies. This study investigates the relationship between vibration perception thresholds (VPTs) at low and high frequencies at two plantar locations and diabetic peripheral neuropathy (DPN) severity in diabetes mellitus (DM) subjects with DPN. We examine differences of VPTs between participants with DM, with DPN, as well as healthy controls. The influence of anthropometric, demographic parameters, and DM duration on VPTs is studied. Thirty-three healthy control group subjects (CG: 56.3 ± 9.9 years) and 33 with DM are studied. DM participants are subdivided into DM group (DM without DPN, n = 20, 53.3 ± 15.1 years), and DPN group (DM with DPN, n = 13, 61.0 ± 14.5 years). VPTs are measured at the first metatarsal head (MTH1) and heel (30 Hz, 200 Hz), using a customized vibration exciter. Spearman and Pearson correlations are used to identify relationships between VPTs and clinical parameters. ANOVAs are calculated to compare VPTs among groups. Significant correlations are observed between DPN severity (by fuzzy scores) and VPTs at both locations and frequencies (MTH1_30 Hz vs. fuzzy: r = 0.68, p = 0.011; Heel_30 Hz vs. fuzzy: r = 0.66, p = 0.014; MTH1_200 Hz vs. fuzzy: r = 0.73, p = 0.005; Heel_200 Hz vs. fuzzy: r = 0.60, p = 0.032). VPTs in CG and DM groups are significantly smaller than the DPN group, showing higher contrasts for the 30 Hz compared to the 200 Hz measurement. The correlations between fuzzy scores and VPTs confirm the relevance of using low and high frequencies to assess a comprehensive foot sensitivity status in people with DM.

Involvement of Cutaneous Sensory Corpuscles in Non-Painful and Painful Diabetic Neuropathy

“…In addition to pain, light touch and low-frequency vibration are also impaired in DDSP [ 13 , 14 , 15 ], suggesting involvement of Aβ fibers and sensory corpuscles (Meissner and Pacinian corpuscles, Merkel cell–neurite complexes; see [ 16 ]). Thus, the analysis of sensory corpuscles in cutaneous biopsies has been proposed as a “gold standard” method of diagnostic interest in some peripheral neuropathies and neurodegenerative diseases (see for a review [ 17 , 18 ]).…”

Addressing Chemotherapy-Induced Peripheral Neuropathy Using Multi-Frequency Vibrometry and Patient-Reported Outcomes

“…Even with large overlaps between grades, finding large correlation coefficients in this study between baseline MF-V and follow-up CIPN18 scores at three months and one year after end of treatment (8–10 points) could hold the potential for CIPN risk ascertainment in conjunction with other risk factors. In regards to other clinically relevant outcomes, a recent study found a greater involvement of low-frequency (30 Hz) VPTs compared to high-frequency VPTs (200 Hz) in patients with diabetic peripheral neuropathy [ 38 ] and earlier MF-V findings in diabetic patients have demonstrated a correlation between low-frequency MF-V and clinically important outcomes such as the risk of diabetic foot ulcers and glycemic control in diabetic children [ 13 , 14 , 39 ]. However, correlation does not necessarily mean good sensitivity and specificity in clinical prediction [ 21 ].…”

The Effect of Subliminal Electrical Noise Stimulation on Plantar Vibration Sensitivity in Persons with Diabetes Mellitus

“…Another potential explanation for the absence of SEN effects lies in the relationship between the disease diabetes and VPT. Although it is generally well accepted that diabetes may lead to an impaired perception of plantar vibratory stimuli (e.g., [ 10 , 44 ]), a recent investigation showed that this is not necessarily the case [ 13 ]: it was shown that the severity of concomitant neuropathic deficits seems to play a more prominent role than diabetes alone [ 13 ]. Hence, we considered the Neuropathy Deficit Score (NDS) from experiment 1 and expected severe deficits to interfere with the effects of SEN stimulation, where disease-induced denervation [ 45 ] was already considered severe.…”

“…A self-written LabVIEW program ran a customized VPT protocol inspired by Mildren et al [ 27 ] that applies several sinusoidal vibration bursts (two seconds duration followed by a two to seven seconds pause) per trial [ 23 ], with the participants pressing a button as soon as they felt the probe vibrate. The mean of the last recognized and the last unperceived vibration stimulus was determined as VPT [ 13 ]. SEN stimulation was performed parallel to the measurement of the VPT.…”

“…Diabetes mellitus is a disease that may lead to degeneration processes in nerve fibers [ 9 , 10 , 11 ], as well as structural and quantitative changes in mechanoreceptors [ 9 , 10 , 11 , 12 ]. Consequently, somatosensation can deteriorate [ 13 ], which is an enormous risk factor for the development of diabetic foot ulcerations [ 14 ]. In the clinical setting, measuring the plantar vibration perception threshold (VPT) is considered an important indicator for detecting patients at risk for developing diabetic foot ulcers [ 15 ].…”