Symptom scoring systems to diagnose distal polyneuropathy in diabetes: the Diabetic Neuropathy Symptom score

Meijer, J. W. G.; Smit, A. J.; Sonderen, Eric van; Groothoff, Johan W.; Eisma, W.H.; Links, Thera P.

doi:10.1046/j.1464-5491.2002.00819.x

Cited by 249 publications

(220 citation statements)

References 26 publications

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“…In addition to this simple test, the DNE score can be used for evaluative purposes. As has been shown earlier, the validation, predictive value, and manageability of the DNE score are good (6,13). We therefore conclude that use of the 128-Hz tuning fork can be recommended for clinical discrimination and screening for the presence of diabetic PNP.…”

Section: Manageabilitymentioning

confidence: 69%

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Back to Basics in Diagnosing Diabetic Polyneuropathy With the Tuning Fork!

Meijer

Smit²,

Lefrandt³

et al. 2005

Diabetes Care

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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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Section: Manageabilitymentioning

confidence: 69%

“…The DNS score has been described in detail elsewhere (6,13). In short, the DNS score is a four-item validated symptom score, with high predictive value to screen for PNP in diabetes (13).…”

Section: Clinical Standardsmentioning

confidence: 99%

Back to Basics in Diagnosing Diabetic Polyneuropathy With the Tuning Fork!

Meijer

Smit²,

Lefrandt³

et al. 2005

Diabetes Care

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“…Another study showed a sensitivity of 79% and specificity of 78% for DNS score as compared to VPT. [17] However, both these scores are more subjective which may result in variability of these indices. The use of VPT for the diagnosis of neuropathy has been well validated by clinical studies with a sensitivity and specificity of 80 and 98%, respectively.…”

Section: Discussionmentioning

confidence: 99%

Perception of vibration threshold is a marker of diabetic neuropathy

Dash¹,

Thakur²

2017

Natl J Physiol Pharm Pharmacol

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Background: Diabetes mellitus is a chronic progressive disorder and is concerned because of its devastating complications. Among this, nervous system is most frequently affected. Symptom varies widely in peripheral neuropathy due to diabetes. In majority of cases, sensory symptoms predominate. Vibration perception threshold (VPT) has added much to early diagnosis of peripheral neuropathy. The previous studies showed that, in mild-to-moderate diabetic neuropathy, VPT serves as excellent tool. Aims and Objectives: This study is planned to assess if VPT testing can be applied as early diagnostic tool in diabetic neuropathy. Materials and Methods: The studies on VPT were conducted in the Department of Physiology with the help of Department of Medicine at VIMSAR, Burla, within the time period of February 2015-November 2015.Vibration sense was detected in 60 diabetic patients, of which 30 had clinical neuropathy and 30 without clinical neuropathy. Chi-square test has been applied between parameters. The instrument used was Vibrotherm Dx. Results: In these 60 diabetic patients, VPT was conducted. This study shows the diverse result of VPT testing. Among the clinical neuropathy patients, 26.66% had Grade I severity and 43.33% had Grade II severity. It was found that in diabetic patients without the clinical neuropathy 50% had Grade I severity and 6.66% had Grade II severity. Hence, it was confirmed that nerve fibers are affected in subclinical states without any symptom. Conclusion: All diabetic patients irrespective of their clinical symptoms of neuropathy should be assessed by VPT testing. It will help to identify at risk group with diabetic peripheral neuropathy by detecting their VPT. It is also a cost-effective procedure. We can also prevent the devastating diabetic foot complications.

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“…The authors used Semmes Weinstein Monofilaments (10 gram) and vibration perception threshold (128 Hz) tests because it has been proven that these tests have a high predictive value for neuropathy in diabetes (Meijer et al 2002) and these tests are quick and easy to perform, without any harm for the patients. Therefore neuropathy was not determined by means of EMG.…”

Section: Effect Of Flat Insoles With Different Shore a Values On Postmentioning

confidence: 99%

“…Thus finally 30 patients (30/79 ¼ 38%), 12 women, 18 men; mean age 62.5 yr (sd ¼ 11.3); range 37 -82 yr with a neuropathy participated in this study. The presence of a neuropathy was determined with the Semmes Weinstein 10 gram Monofilaments and the Vibration Perception Threshold 128 Hz (Meijer et al 2002).…”

Section: Subjectsmentioning

confidence: 99%

Effect of flat insoles with different Shore A values on posture stability in diabetic neuropathy

Geffen¹,

Dijkstra²,

Hof³

et al. 2007

Prosthetics &Amp; Orthotics International

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The objective of the study was to determine whether insoles with a low Shore A value (158) as prescribed for patients with a diabetic neuropathy have a negative effect on posture stability because these insoles may reduce somatosensory input under the feet. It was conducted in the Center for Rehabilitation, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands The study was observational and conducted on 30 diabetic patients (aged 37 -82 years) with a neuropathy. Posture stability (body sway) was assessed in a shoe without insole, on a flat insole with a low Shore A value (158) and on a flat insole with a higher Shore A value (308). These assessments were done under four different conditions: (1) eyes open, no dual-task, (2) eyes closed, no dual-task, (3) eyes open, dual-task (mental arithmetic) and (4) eyes closed, dual-task. Additionally 10 healthy controls (aged 27 -51 years) were assessed similarly. A significantly higher root-mean-square (rms) value of the anterior-posterior velocity, V y , was found in patients compared with controls (3.4 cm/s vs. 1.2 cm/s, p 5 0.05). Also a significant difference in rms value of the anterior-posterior velocity, V y , was found between eyes open and eyes closed (1.9 cm/s vs. 2.7 cm/s, p 5 0.05). No significant effects were found for insoles or dual tasks for the total group. In diabetic patients no significant effect was found of insoles on posture stability. The effect of closed eyes on posture stability was significantly larger for diabetic patients compared to controls. It was found that prescribing insoles with a low Shore A value (158), compared to insoles with a higher Shore A value (308) has no significant negative effect on posture stability in patients with a diabetic neuropathy.

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Symptom scoring systems to diagnose distal polyneuropathy in diabetes: the Diabetic Neuropathy Symptom score

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

Cited by 249 publications

References 26 publications

Back to Basics in Diagnosing Diabetic Polyneuropathy With the Tuning Fork!

Back to Basics in Diagnosing Diabetic Polyneuropathy With the Tuning Fork!

Perception of vibration threshold is a marker of diabetic neuropathy

Effect of flat insoles with different Shore A values on posture stability in diabetic neuropathy

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