The Comparison of Good Clinical Examination (GCE) and Vibration Perception Threshold (VPT) In Diagnosis of Diabetic Sensory Neuropathy

Abstract

Background: Diabetic neuropathy is one of the most common complications of diabetes, resulting from damaged nerves near the extremities and carrying clinical implications in terms of several morbidities. Prompt and accurate diagnosis is essential for effective management and prevention. Objective: To compare the diagnostic accuracy of Good Clinical Examination (GCE) and Vibration Perception Threshold (VPT) in diabetic sensory neuropathy. Methods: A cross-sectional study was conducted at the Department of Endocrinology, Hayatabad Medical Complex, Peshawar, from May 2023 to April 2024. A total of 120 patients with diabetes mellitus were enrolled. All participants underwent a complete clinical examination for symptoms suggestive of neuropathy, reflexes, and sensory tests according to GCE. Additionally, VPT measurements were recorded at various points on the body, including the medial malleolus, using a biothesiometer. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for both diagnostic methods. Statistical analysis was performed using SPSS software version 25.0, and receiver operating characteristic (ROC) curves were used to evaluate diagnostic accuracy. Results: The mean age of participants was 56.3 ± 12.4 years. The sensitivity, specificity, PPV, and NPV of GCE for diagnosing diabetic sensory neuropathy were 75.0%, 85.0%, 70.0%, and 88.0%, respectively. For VPT, these values were 90.0%, 80.0%, 83.0%, and 88.0%, respectively. Combining GCE and VPT resulted in a sensitivity of 92%, specificity of 88%, PPV of 85%, and NPV of 90%. Conclusion: Both GCE and VPT are useful in diagnosing diabetic sensory neuropathy, but their combination improves diagnostic accuracy. The integrated use of GCE and VPT is recommended for comprehensive and reliable diagnosis.