Detection Of Diabetic Polyneuropathy Research Articles

Assessing Corneal Confocal Microscopy and Other Small Fiber Measures in Diabetic Polyneuropathy.

Damage to small nerve fibers is common in diabetic polyneuropathy (DPN), and the diagnosis of DPN relies on subjective symptoms and signs in a combination with objective confirmatory tests, typically electrophysiology or intraepidermal nerve fiber density (IENFD) from skin biopsy. Corneal confocal microscopy (CCM) has been introduced as a tool to detect DPN. However, it is unclear if CCM can reliably be used to diagnose DPN and how the technique compares with other commonly used measures of small fiber damage, such as IENFD, cold detection threshold (CDT), and warm detection threshold (WDT). Therefore, we assessed and compared the use of CCM, IENFD, CDT, and WDT in the diagnosis of DPN in patients with type 2 diabetes. In this cohort study, the participants underwent detailed neurologic examination, electrophysiology, quantification of IENFD, CCM, and quantitative sensory testing. Definition of DPN was made in accordance with the Toronto criteria for diabetic neuropathy (without relying on IENFD and thermal thresholds). A total of 214 patients with at least probable DPN, 63 patients without DPN, and 97 controls without diabetes were included. Patients with DPN had lower CCM measures (corneal nerve fiber length [CNFL], nerve fiber density, and branch density), IENFD, CDT, and WDT compared with patients without DPN (p ≤ 0.001, <0.001, 0.002, p < 0.001, p = 0.003, and <0.005, respectively), whereas there was no difference between controls and patients with diabetes without DPN. All 3 CCM measures showed a very low diagnostic sensitivity with CNFL showing the highest (14.4% [95% CI 9.8-18.4]) and a specificity of 95.7% (88.0-99.1). In comparison, the sensitivity of abnormal CDT and/or WDT was 30.5% (24.4-37.0) with a specificity of 84.9% (74.6-92.2). The sensitivity of abnormal IENFD was highest among all measures with a value of 51.1% (43.7-58.5) and a specificity of 90% (79.5-96.2). CCM measures did not correlate with IENFD, CDT/WDT, or neuropathy severity in the group of patients with DPN. CCM measures showed the lowest sensitivity compared with other small fiber measures in the diagnosis of DPN. This indicates that CCM is not a sensitive method to detect DPN in recently diagnosed type 2 diabetes. This study provides Class III evidence that CCM measures aid in the detection of DPN in recently diagnosed type 2 diabetics but with a low sensitivity when compared with other small fiber measures.

Detection of diabetic polyneuropathy in a family medicine clinic by using monofilament

Background/Aim. Diabetic polyneuropathy (DPN) is the most common microvascular complication of diabetes mellitus (DM), which may be present at the time of disease detection. Screening for DPN is performed for the patients with type 2 diabetes at the time of diagnosis and for type 1 diabetes 5 years after diagnosis. The primary aim of this study was to determine the prevalence of DNP among family medicine patients with DM aged 18 to 70 years using nylon monofilament. Methods. The cross-sectional study estimated the prevalence of DPN among primary care patients with DM in Banja Luka, Republic of Srpska, Bosnia and Herzegovina. Semmes-Weinstein nylon 10 g monofilament was used to detect DPN. Age, gender, duration of DM, type of therapy, symptoms, glycosylated hemoglobin (HbA1c), and risk factors (hypertension, smoking, dyslipidemia, obesity, physical inactivity) were analyzed. Data collection took place from June 1st, 2017 to May 31st, 2018. Results. The study included 228 patients, 132 (57.9%) men and 96 (42.1%) women. There was a statistically significant difference in the presence of all symptoms of DPN (tingling, burning, light burning, and stinging) among patients with different duration of DM (p &lt; 0.01). Multivariate logistic regression revealed that patients who had hypertension [odds ratio (OR) = 26.2; 95% confidence interval (CI): 4.070?168.488; p = 0.001], used oral anti-diabetic therapy (OR = 12.3; 95% CI: 1.300?116.309; p = 0.029), had tingling (OR = 5.2; 95% CI: 1.431?18.571; p = 0.012) and a longer duration of diabetes (OR = 4.27; 95% CI: 1.983?9.175; p = 0.000) were more likely to have DPN. Conclusion. The prevalence of DPN in family medicine patients with DM using nylon monofilament was 24.2%. Determinants of DNP were the presence of symptoms of tingling, duration of diabetes, hypertension, and the use of oral antidiabetic therapy alone.

English

Diabetes is a major public health problem. 285 million persons worldwide have diabetes, of these 51 million are in India. Diabetic peripheral neuropathy is a major microvascular complication of diabetes. Conventional methods used for the diagnosis of diabetic peripheral neuropathy in clinical practice have limited effectiveness. Since peripheral sensory neuropathy is a pivotal element in the causal pathway to both foot ulceration and amputation, screening and early identification of neuropathy offer a crucial opportunity for the patient with diabetes to actively modulate the course of suboptimal glycaemic control to currently recommended targets, and to implement improved foot care before the onset of significant morbidity. This study was carried out to evaluate the usefulness of simple bed side screening modalities for peripheral neuropathy like vibration perception threshold measurement with biothesiometer, 10g semmes-weinstein monofilament, diabetic neuropathy examination and symptom scores and ankle reflex testing in patients with diabetes mellitus and to seek an optimal screening method in diabetic clinic. INTRODUCTION:Diabetes mellitus comprises a group of common metabolic disorders that share the phenotype of hyperglycaemia. The two broad categories of DM are designated as type 1 and type 2.Type 2 diabetes mellitus is a heterogenous group of disorders characterized by variable degrees of insulin resistance, impaired insulin secretion and increased glucose production. The number of patients with type 2 diabetes is increasing by epidemic proportions in the world, particularly in India. There is a long presymptomatic phase before the appearance of symptoms of type 2 diabetes. Therefore, Type 2 diabetes is frequently not diagnosed until complications have already occurred. Complications of DM are subdivided into microvascular (retinopathy, neuropathy, nephropathy) and macrovascular complications (coronary artery disease (CAD), peripheral arterial disease (PAD), cerebrovascular disease). Lower extremity disease, including peripheral neuropathy, foot ulceration, peripheral arterial disease, or lower extremity amputation, is twice as common in diabetic persons compared with non-diabetic persons and it affects 30 per cent of diabetic persons who are older than 40 yr 1 . Diabetic Neuropathy (DN) develops in about 4-10% of diabetic patients after 5 years and in 15% after 20 years 2 . AIMS AND OBJECTIVES: To evaluate the usefulness of the diabetic neuropathy examination score (DNE), diabetic neuropathy symptom (DNS) score, 10-g Semmes-Weinstein monofilament examination, ankle reflex and measuring vibration perception threshold (VPT) with a biothesiometer in the detection of diabetic polyneuropathy in type 2 diabetes patients and to seek an optimal screening method in diabetic clinic in the detection of diabetic polyneuropathy in type 2 diabetes patients.

A Comparative study of examination scores and quantitative sensory testing in diagnosis of diabetic polyneuropathy

Context:Many advances have taken place in the detection of diabetic polyneuropathy with respect to examination scores, electrophysiological techniques and quantitative sensory testing.Aim:This study aims to evaluate the discriminative power of the Diabetic Neuropathy Examination Score (DNE), 10-g Semmes-Weinstein Monofilament Examination (SWME) and Quantitative Sensory Testing by Vibration Perception Threshold (VPT) in the diagnosis of diabetic polyneuropathy and seek an optimal screening method in diabetic clinic.Materials and Methods:Hundred consecutive patients with Type 2 diabetes were subjected to Diabetic Neuropathy Symptom Score, DNE score, Semmes-Weinstein monofilament examination, Vibration Perception Threshold and Nerve Conduction Studies; mean ± SD for the various characteristics were calculated. Sensitivity and specificity for the DNE, SWME and VPT were calculated, taking NCS as gold standard.Results:Seventy one of 100 subjects had evidence of neuropathy confirmed by Nerve Conduction Studies, while 29 did not have neuropathy. The DNE score gave a sensitivity of 83% and a specificity of 79%. The sensitivity of SWME was 98.5% and specificity was 55%. Vibration Perception Thresholds yielded a sensitivity of 86% and a specificity of 76%.Conclusions:A simple neurological examination score is as good as Vibration Perception threshold in evaluation of polyneuropathy in a diabetic clinic. It may be a better screening tool for diagnosis of diabetic polyneuropathy in view of the cost effectiveness and ease of applicability.