Diagnostic criteria for diabetic polyneuropathy in a population study

Abstract

Population surveys are of high informative value and reflect the actual prevalence of diabetic polyneuropathy (DPN) in society. The purpose of the present study was to examine the spread of DPN among patients with type 1 diabetes mellitus (DM) and to assess the diagnostic value of used diagnostic methods. Three hundred and forty-six patients (100 children and adolescents and 246 adults) with type 1 DM, living in Moscow and its region were examined. The criteria adopted at the Conference on Standardization of DPN Diagnosis in Saint Antonio in 1992 were used to diagnose DPN. The criteria proposed by P. Dyck et al. were applied to define DPN stages. The prevalence of DPN in the children and adolescents was 40%, the vast majority (75%) of the patients having subclinical (la and lb) stages of DPN. Autonomic deficit was revealed in 17% of the children and adolescents with type 1 DM. In the adults, the prevalence of DPN was 66.3% with a predominance (61%) of the clinical stages (2a and 2b) stages of DPN. Autonomic deficit was detected in 25.6% of the adults with type 1 DM. The most sensitive diagnostic tests in the examination of children and adolescents were found to be a neurological examination by using the NIS-LL scale (for neuropathic disorders), as well as temperature sensitivity study, and stimulation EMG. While examining the adults, an active detection of complaints showed a high sensitivity (79%) by applying the existing scales, which makes it possible to use this method at the first stage of a diagnostic search. The study of temperature sensitivity by employing the Thioterm tool increased the diagnostic value of a neurological examination by means of the NIS-LL in all age groups.