Michigan Neuropathy Screening Instrument Questionnaire Research Articles

Comparison of intraepidermal nerve fiber density and confocal corneal microscopy for neuropathy.

Compare the diagnostic characteristics of intraepidermal nerve fiber density (IENFD) and confocal corneal microscopy (CCM) for distal symmetric polyneuropathy (DSP) and small fiber neuropathy (SFN). Participants with obesity were recruited from bariatric surgery clinics and testing was performed prior to surgery. DSP and SFN were determined using the Toronto consensus definitions of probable neuropathy. IENFD was assessed from 3 mm punch biopsies of the distal leg and proximal thigh. CCM was performed on both eyes with manual and automated counting. The Michigan Neuropathy Screening Instrument questionnaire (MNSIq) was also completed. Diagnostic capability was determined using areas under the receiver operating characteristics curve (AUC) from logistic regression. We enrolled 140 participants (mean [standard deviation [SD]] age: 50.3 years [7.1], 77.1% female, BMI: 44.4 kg/m2 [6.7]). In this population, 22.9% had DSP and 14.3% had SFN. Distal leg IENFD had the largest AUC (95% confidence interval) for DSP (0.78, 0.68-0.89) and SFN (0.85, 0.75-0.96). Proximal thigh IENFD (DSP: AUC: 0.59, 0.48-0.69, SFN: AUC: 0.59, 0.46-0.73) and CCM metrics (DSP: AUC range: 0.55-0.60, SFN: AUC range: 0.45-0.62) had poorer diagnostic capability than distal leg IENFD for DSP/SFN (P < 0.05). MNSIq had similar diagnostic capability to distal leg IENFD for both DSP/SFN (DSP: AUC: 0.76, 0.68-0.85, SFN: AUC: 0.81, 0.73-0.88). More participants (52%) preferred skin biopsies to CCM. Distal leg IENFD was the best quantitative measure of DSP/SFN. CCM had poor diagnostic characteristics and fewer patients preferred this test to IENFD. The MNSIq had similar diagnostic characteristics to distal leg IENFD, indicating its value as a diagnostic tool in the clinical setting. clinicaltrials.gov: NCT03617185.

Efficacy and Safety of the Combination of Palmitoylethanolamide, Superoxide Dismutase, Alpha Lipoic Acid, Vitamins B12, B1, B6, E, Mg, Zn and Nicotinamide for 6 Months in People with Diabetic Neuropathy.

To investigate the efficacy of Palmitoylethanolamide (PEA, 300 mg), Superoxide Dismutase (SOD, 70 UI), Alpha Lipoic Acid (ALA, 300 mg), vitamins B6 (1.5 mg), B1 (1.1 mg), B12 (2.5 mcg), E (7.5 mg), nicotinamide (9 mg), and minerals (Mg 30 mg, Zn 2.5 mg) in one tablet in people with Diabetic Neuropathy (DN). In the present pilot study, 73 people (age 63.0 ± 9.9 years, 37 women) with type 2 Diabetes Mellitus (DMT2) (duration 17.5 ± 7.3 years) and DN were randomly assigned to receive either the combination of ten elements (2 tablets/24 h) in the active group (n = 36) or the placebo (n = 37) for 6 months. We used the Michigan Neuropathy Screening Instrument Questionnaire and Examination (MNSIQ and MNSIE), measured vibration perception threshold (VPT) with biothesiometer, and Cardiovascular Autonomic Reflex Tests (CARTs). Nerve function was assessed by DPN Check [sural nerve conduction velocity (SNCV) and amplitude (SNAP)]. Sudomotor function was assessed with SUDOSCAN, which measures electrochemical skin conductance in hands and feet (ESCH and ESCF). Pain score (PS) was assessed with Pain DETECT questionnaire. Quality of life was assessed by questionnaire. In the active group, there was a large improvement of pain (PS from 20.9 to 13.9, p < 0.001). There was also a significant improvement of vitamin B12 (B12) levels, MNSIQ, SNCV, VPT, and ESCF (222.1 vs. 576.3 pg/ mL, p < 0.001; 6.1 vs. 5.9, p = 0.017; 28.8 vs. 30.4, p = 0.001; 32.1 vs. 26.7, p = 0.001; and 72.2 vs. 74.8, p < 0.001 respectively). In the placebo group, neither pain (21.6 vs. 21.7, p = 0.870) or any other aforementioned parameters changed significantly, and MNSIE worsened (2.9 vs. 3.4, p < 0.001). As a result, changes from baseline to follow-up in pain, B12 levels, VPT, and MNSIQ differed significantly between the two groups (p < 0.001, 0.025, 0.009, and <0.001, respectively). CARTs, SNAP, ESCH did not significantly change in either of the two groups. The combination of the ten elements in one tablet for 6 months at a daily dose of two tablets in people with DN significantly improves pain, vibration perception threshold, and B12 levels.

Prevalence of painful and painless diabetic peripheral neuropathy in the Northern Danish Region: A population-based study

BackgroundDiabetic peripheral neuropathy (DPN) is a common complication of diabetes, yet varying estimates of its prevalence exist. The present study aimed to estimate a questionnaire-centered prevalence of painful and painless DPN in the Northern Danish Region, examine its geographical distribution within the region, and investigate associations between DPN and potential risk factors. MethodsA questionnaire-based survey was sent to all persons living with diabetes in the Northern Danish Region using electronic mail. Persons with diabetes were identified using The National Health Insurance Service Registry. The survey included information on demographics, socioeconomics, municipality, diabetes type, duration, and treatment, as well as the validated questionnaires Michigan Neuropathy Screening Instrument-questionnaire (MNSIq) and the Douleur Neuropathique en 4 Questions (DN4)-interview. Possible DPN was defined as an MNSIq-score ≥ 4, while possible painful DPN was defined as pain in both feet and a DN4-interview score ≥ 3. ResultsA total of 23,206 eligible people were identified as having diabetes and approximately 33 % answered all questionnaires. The prevalence of possible DPN was 23.3 % (95 % CI: 22.4–24.3 %), while the prevalence of possible painful DPN was 18.0 % (17.1–18.8 %). The prevalence of possible DPN ranged from 22.1 % to 35.0 % between municipalities, while the prevalence of possible painful DPN ranged from 15.6 % to 20.0 %. High body-mass index, long diabetes duration, insulin use, glucagon-like-peptide-1-analogue use, and low income were associated with increased risk of DPN. ConclusionThe high prevalence of possible painless and painful DPN emphasizes the need for better prevention and careful screening even in high-income countries.

Lipid Levels and Risk of Diabetic Polyneuropathy in 2 Danish Type 2 Diabetes Cohorts.

Reduction of blood lipids may aid in preventing diabetic polyneuropathy (DPN), but evidence remains conflicting. We investigated the association between lipid parameters and DPN risk in individuals with type 2 diabetes mellitus (T2DM). We conducted a population-based cohort study of individuals with newly diagnosed T2DM and a cross-sectional study using a clinically recruited T2DM cohort. Triglycerides, high-density lipoprotein (HDL), low-density lipoprotein (LDL), and non-HDL cholesterol were measured in routine diabetes care. Each lipid parameter was categorized according to the latest cutoffs in clinical guidelines on dyslipidemia. DPN was assessed with validated hospital diagnosis codes in the population-based cohort and with the Michigan Neuropathy Screening Instrument questionnaire in the clinical cohort. We calculated hazard ratios (HRs) using Cox regression and prevalence ratios (PRs) using Poisson regression. We included 61,853 individuals in the population-based cohort (median age 63 [quartiles 54-72] years) and 4,823 in the clinical cohort (median age 65 [quartiles 57-72] years). The incidence rate of hospital-diagnosed DPN in the population-based cohort was 3.6 per 1000 person-years during a median follow-up of 7.3 years. Achieving guideline targets for HDL, LDL, and non-HDL cholesterol showed no association with DPN risk. By contrast, adjusted HRs (95% CI) for DPN were 1.02 (0.89-1.18) for triglyceride levels between 150 and 204 mg/dL (1.7-2.3 mmol/L) and 1.28 (1.13-1.45) for levels >204 mg/dL (2.3 mmol/L). In the clinical cohort with a DPN prevalence of 18%, DPN associated strongly with triglycerides >204 mg/dL (2.3 mmol/L) with an adjusted PR (95% CI) of 1.40 (1.21-1.62). The prevalence of DPN was modestly elevated for individuals with HDL cholesterol <39 mg/dL (1.0/1.3 mmol/L) in men and <50 mg/dL (1.3 mmol/L) in women (PR 1.13 [0.99-1.28]) and for individuals with non-HDL cholesterol >131 mg/dL (3.4 mmol/L) (PR 1.27 [1.05-1.52]). In both cohorts, spline models showed an increasing risk of DPN starting from triglyceride levels >124 mg/dL (1.4 mmol/L). All results were similar among statin users. High triglyceride levels are a strong DPN risk factor. Future intervention studies shall determine whether triglyceride reduction is more important for DPN prevention than reduction of other lipids.

Longitudinal Change in Serum Neurofilament Light Chain in Type 2 Diabetes and Early Diabetic Polyneuropathy: ADDITION-Denmark.

To investigate the longitudinal development of neurofilament light chain (NfL) levels in type 2 diabetes with and without diabetic polyneuropathy (+/-DPN) and to explore the predictive potential of NfL as a biomarker for DPN. We performed retrospective longitudinal case-control analysis of data from 178 participants of the Anglo-Danish-Dutch Study of Intensive Treatment in People with Screen-Detected Diabetes in Primary Care-Denmark (ADDITION-Denmark) cohort of people with screen-detected type 2 diabetes. Biobank samples acquired at the ADDITION-Denmark 5- and 10-year follow-ups were analyzed for serum NfL (s-NfL) using single-molecule array, and the results were compared with established reference material to obtain NfL z-scores. DPN was diagnosed according to Toronto criteria for confirmed DPN at the 10-year follow-up. s-NfL increased over time in +DPN (N = 39) and -DPN participants (N = 139) at levels above normal age-induced s-NfL increase. Longitudinal s-NfL change was greater in +DPN than in -DPN participants (17.4% [95% CI 4.3; 32.2] or 0.31 SD [95% CI 0.03; 0.60] higher s-NfL or NfL z-score increase in +DPN compared with -DPN). s-NfL at the 5-year follow-up was positively associated with nerve conduction studies at the 10-year follow-up (P = 0.02 to <0.001), but not with DPN risk. Areas under the curve (AUCs) for s-NfL were not inferior to AUCs for the Michigan Neuropathy Screening Instrument questionnaire score or vibration detection thresholds. Higher yearly s-NfL increase was associated with higher DPN risk (odds ratio 1.36 [95% CI 1.08; 1.71] per 1 ng/L/year). Our findings suggest that preceding s-NfL trajectories differ slightly between those with and without DPN and imply a possible biomarker value of s-NfL trajectories in DPN.

A study on prevalence of diabetic peripheral neuropathy in diabetic patients attending a rural health and training centre.

Diabetic neuropathy is a common complication, affecting up to half the diabetics. Diabetic peripheral neuropathy (DPN) predominantly affects the hands and lower limbs. It leads to loss of protective sensation, resulting in continuous injury to insensitive feet. The early detection of DPN using an objective screening test followed by its appropriate management is important, as up to 50% of diabetic peripheral neuropathies may be asymptomatic. To screen diabetic patients attending a Rural Health and Training Centre of a medical college in Tamil Nadu for DPN. To assess the association between DPN and sociodemographic factors, duration of diabetes, glycemic control, physical activity, body mass index, smoking and habit of alcohol consumption. The study was conducted among 206 diabetic patients attending a Rural Health and Training Centre. Participants were assessed using the Michigan Neuropathy Screening Instrument (MNSI), which involves using a questionnaire followed by a physical examination. Of the 206 patients, 61.2% were male, and 38.8% were female. The mean age was 50.86 years (standard deviation [SD] = 12.26 years). The mean duration of diabetes was 8.3 years (SD = 5.5 years). The proportion of diabetics who were screened positive for peripheral neuropathy was 16.5% and 21.8% using the MNSI questionnaire and examination, respectively. Age of 60 years and above was significantly associated with DPN.(OR = 3.982, P value = 0.0001). Duration of more than 5 years of diabetes was also significantly associated with DPN.(OR = 6.01, P value = 0.003). A high proportion of diabetics were screened positive for peripheral neuropathy, and many of them were unaware of having the complication. Many risk factors associated with DPN were reported in this study. Thus, early diagnosis and management with MNSI or any other validated screening tool in health care institutions is essential.

Small fiber neuropathy in irritable bowel syndrome.

In this study, we intend to evaluate the occurrence of small fiber neuropathy in patients with irritable bowel syndrome (IBS). Small fiber neuropathy (SFN) is a sensory neuropathy that results from the degeneration of small Aδ and unmyelinated C fibers. SFN manifests positive symptoms, such as tingling, burning, prickling, and aching, and negative symptoms, including numbness, tightness, and coldness. The SFN coexistence with other comorbidities (e.g., fibromyalgia, inflammatory bowel disease, celiac disease) has been reported in previous studies. We conducted a cross-sectional study to assess the coexistence of SFN and IBS. Forty-two IBS patients and forty-three healthy individuals were asked to complete the Michigan Neuropathy Screening Instrument (MNSI) questionnaire. Results greater than three (>3) were considered positive. Participants with positive MNSI questionnaire results were examined for any neuropathy signs according to the Utah Early Neuropathy Scale (UENS) examination. The participants with positive results for the questionnaire and examination were checked for the sural and the superficial peroneal nerve conduction study (NCS). Normal NCS represented intact large fibers and the diagnosis of SFN. Ten participants, 7 (16.7 %) in the IBS group and 3 (6.9 %) in the healthy group, had positive results for the questionnaire. Four participants were positive for the examination, with normal NCS, and were classified as SFN-positive. All four SFN diagnoses were from the IBS group. No one in the healthy group was diagnosed with SFN. We could find a significant statistical difference (p<0.05) between the IBS and healthy groups regarding the prevalence of SFN diagnosis. The co-occurrence of SFN and IBS suggests the possibility of a generalized neuropathy syndrome characterized by widespread neuronal impairment. Thus, any peripheral neuropathy symptom in IBS patients (and potentially other chronic pain disorders) should be evaluated for SFN since timely diagnosis and proper treatment result in a better quality of life for the patients.

THU347 Diffusion Tensor Imaging Of The Tibial Nerve Can Detect Peripheral Neuropathy In Type 2 Diabetes

Abstract Disclosure: H. Park: None. E. Oh: None. S. Park: None. H. Kim: None. D. Byun: None. Magnetic resonance imaging (MRI) has played little role for the study of peripheral nerve disease. However, recent technological advances in MRI have provided us more information about neural microstructure and higher resolution in peripheral nerves. The aim of this study is to evaluate whether diffusion tensor imaging (DTI) parameters in MRI can detect peripheral neuropathy in type 2 diabetes (T2D). In this prospective, single-center study, eight T2D patients (mean age, 62.1 ± 10.8 yr; 5 M/ 3F) with peripheral neuropathy and seven healthy controls (65.0 ± 3.3 yr, 7 F) were included. All T2D patients underwent Michigan Neuropathy Screening Instrument questionnaire and quantitative sensory testing. MRI including DTI and axial T2-weight Dixon sequence was performed for each participant. Region of interest analysis was independently performed by one radiologist on each side of tibial nerve at two levels: lower margin of adductor magnus muscle insertion (level 1), and quadriceps femoris tendon at patellar attachment (level 2). DTI parameters including cross-sectional areas (CSA), fractional anisotropy (FA), as well as diffusivity (mean (MD), axial (AD), and radial (RD)) were calculated. FA was significantly lower in T2D patients with peripheral neuropathy than healthy controls at both level 1 (396 ± 74 vs. 541 ± 141, P&amp;lt;0.05) and level 2 (422 ± 65 vs. 565 ± 108, P&amp;lt;0.05). AD was significantly lower in T2D patients with peripheral neuropathy than controls at level 2 (2,207 ± 492 vs. 2,884 ± 497, P&amp;lt;0.05). RD was significantly higher in T2D patients with peripheral neuropathy than controls at level 1 (1,156 ± 313 vs. 867 ± 147, P&amp;lt;0.05). No difference in the CSA of the tibial nerve was seen in both levels between two groups. Our results have shown that DTI parameters can detect nerve abnormalities of the tibial nerve in T2D patients, suggesting DTI may be useful as a biomarker in diabetic peripheral neuropathy. Presentation: Thursday, June 15, 2023

Prevalence and Risk Factors for Diabetic Peripheral Neuropathy among Patients with Type 2 Diabetes in Saudi Arabia: A Cross-sectional Study.

Neuropathy is the most prevalent among diabetes-related microvascular complications, of which distal symmetric polyneuropathy is very extensive. This study aimed to evaluate the frequency and risk factors for Diabetic Peripheral Neuropathy (DPN) among Type 2 Diabetes (T2D) in Saudi Arabia. This study included 238 patients with T2D, between 18 and 80 years of age. Using a structured questionnaire, data on the sociodemographic characters of the study group and laboratory tests were collected. Distal symmetrical peripheral neuropathy in patients with diabetes was identified using the Michigan Neuropathy Screening Instrument (MNSI). In this cohort, 66 patients (27.7%) had positive MNSI questionnaire scores (≥ 7) and 90 (37.8%) patients had positive examination scores (≥ 2.5). From the patient's perception, patients on oral plus insulin treatment exhibited a higher risk for DPN (OR 2.95; p = 0.018) than those who received only oral treatment and an ulcer in an earlier period exhibited a higher risk for DPN (OR: 3.25; p = 0.005). From the health professionals' perception, more females than males showed a high risk for DPN (OR: 3.92; p = 0004). Likewise, compared to the patients in the age group of <50 years, those in the age group of ≥50 years revealed a high risk for DPN (OR 6.30; p = 0.009). Further, patients on oral and insulin treatments were at greater risk for DPN (OR: 3.71; p = 0.024); patients experiencing complications like prior ulcers, and high-density lipoprotein also exhibited higher risk than the patients who lacked them. Diabetes neuropathy is one of the most common complications of microangiopathy experienced by patients with T2D in Saudi Arabia. The risks for DPN among patients with T2D can be reduced with the implementation of focused and evidence-based interventions.

491-P: Corneal Nerve Sensitivity—Early Detection of Diabetic Peripheral Neuropathy (DPN)

Introduction: Density of sub-epithelial corneal nerves have been promoted as a surrogate marker for early diagnosis of DPN. As an alternative, we developed an objective functional test of corneal sensitivity (Invest Ophthalmol Vis Sci. 2016, 57: 2412-9). In this study we provide verification of this methodology in human subjects with DPN. Methods: Following verification of DPN, response to a drop of isotonic vs. 5% NaCl (hypertonic) solution was recorded (primary endpoint). Ratio of time that the eyelids were closed from 10s to 60s following application of each solution were quantified using an image analysis program. Results: We examined 24 subjects with type 2 diabetes and 12 age-matched controls. The presence of DPN in diabetes vs. control subjects was verified by completing the Michigan Neuropathy Screening Instrument questionnaire and lower extremity examination including amplitude and conduction velocity of the sural nerve. The presence of eye discomfort was examined for each subject by completing the DEQ5 and Ocular Surface Disease Index (OSDI) questionnaires. DPN was confirmed in all subjects with diabetes as well as presence of mild to moderate ocular surface disease. Two control subjects had mild ocular surface disease but no peripheral neuropathy. Cochet-Bonnet filament esthesiometer examination revealed significant corneal sensitivity impairment in subjects with diabetes vs. control subjects (5.64 ± 0.08 vs. 5.97 ± 0.03 cm, respectively). Corneas of subjects with diabetes were also significantly less sensitive vs. controls to application of hypertonic solution (0.18 ± 0.01 vs. 0.29 ± 0.04, respectively). Data is presented as mean ± S.E.M. There was no difference in sensitivity to the isotonic solution. Conclusion: Corneal nerves that penetrate the epithelium and sprout near the surface of the eye and are the first to exhibit the "dying-back" phenomenon associated with DPN. Clinical evaluation of the sensitivity of these nerves could be a valuable method for early detection of DPN. Disclosure M.A.Yorek: Consultant; Novo Nordisk. M.Correia: Research Support; Eli Lilly and Company, Novartis, Novo Nordisk. R.Kardon: None. P.Poolman: Stock/Shareholder; FaceX LLC. Funding U.S. Department of Veterans Affairs (RX000889)

The Prevalence of Polyneuropathy in Type 2 Diabetes Subgroups Based on HOMA2 Indices of β-Cell Function and Insulin Sensitivity.

Metabolic syndrome components may cumulatively increase the risk of diabetic polyneuropathy (DPN) in type 2 diabetes mellitus (T2DM) patients, driven by insulin resistance and hyperinsulinemia. We investigated the prevalence of DPN in three T2DM subgroups based on indices of β-cell function and insulin sensitivity. We estimated β-cell function (HOMA2-B) and insulin sensitivity (HOMA2-S) in 4,388 Danish patients with newly diagnosed T2DM. Patients were categorized into subgroups of hyperinsulinemic (high HOMA2-B, low HOMA2-S), classical (low HOMA2-B, low HOMA2-S), and insulinopenic (low HOMA2-B, high HOMA2-S) T2DM. After a median follow-up of 3 years, patients filled the Michigan Neuropathy Screening Instrument questionnaire (MNSIq) to identify DPN (score ≥ 4). We used Poisson regression to calculate adjusted prevalence ratios (PRs) for DPN, and spline models to examine the association with HOMA2-B and HOMA2-S. A total of 3,397 (77%) patients filled in the MNSIq. The prevalence of DPN was 23% among hyperinsulinemic, 16% among classical, and 14% among insulinopenic patients. After adjusting for demographics, diabetes duration and therapy, lifestyle behaviors, and metabolic syndrome components (waist circumference, triglycerides, HDL cholesterol, hypertension, and HbA1c), the PR of DPN was 1.35 (95% CI 1.15-1.57) for the hyperinsulinemic compared with the classical patients. In spline analyses, we observed a linear relation of higher DPN prevalence with increasing HOMA2-B, independent of both metabolic syndrome components and HOMA2-S. Hyperinsulinemia marked by high HOMA2-B is likely an important risk factor for DPN beyond metabolic syndrome components and insulin resistance. This should be considered when developing interventions to prevent DPN.

Reliability and Validity of Mini-Balance Evaluation System Test in Type 2 Diabetic Patients with Peripheral Neuropathy.

Type 2 diabetic peripheral neuropathy is known to cause balance limitations in static, dynamic, and functional activity. The Mini-BESTest, a shortened version of BESTest, was evolved to identify balance disorders within a short duration. No prior studies have yet been conducted to assess the usefulness of Mini-BESTest in the diagnosis of type 2 diabetic peripheral neuropathy. The current study aimed to examine the reliability and discriminant validity by comparing the Mini-BESTest scores between type 2 diabetic patients with peripheral neuropathy, divided into two 2 groups based on reporting scores of <4 and ≥4 in the MNSI questionnaire, respectively. Therefore, a cross-sectional study design was conducted including 44 type 2 diabetic patients (4 males and 40 females; aged 56.61 ± 7.7 years old). Diabetic peripheral neuropathy was diagnosed by physical assessment using the Michigan Neuropathy Screening Instrument (MNSI). Inter-rater (two physiotherapists) and Intra-rater (7–10 days) reliability of the Mini-BESTest were explored with intraclass correlation coefficients (ICC2,1) and (ICC3,1). The Mini-BESTest presented an excellent inter-rater reliability (ICC2,1= 0.95, 95% CI = 0.91–0.97, SEM = 0.61) and an excellent intra-rater reliability (ICC3,1 = 0.93, 95% CI = 0.87–0.96, SEM = 0.66), with confirmation by a good agreement presented by the Bland–Altman plots. The internal consistency measured with the overall Cronbach’s alpha showed an acceptable agreement (0.73). The MDC was 2.16. In addition, the Mini-BESTest scores in the type 2 diabetic neuropathy patients reporting MNSI questionnaire scores <4 was found to be significantly higher when compared with those reporting scores ≥4. The Mini-BESTest can be used as a highly reliable and valid clinical application in the population with type 2 diabetic peripheral neuropathy.

461-P: Prevalence and Patient Recognition of Distal Symmetric Neuropathy (DSP) in a Predominantly Low-Income U.S. Patient Population

Introduction: DSP is a disabling, painful condition among individuals with glucose intolerance. Patient awareness of DSP is essential to reduce the risk of infection and amputation. While DSP risk factors, such as glucose intolerance, are more common among Black people and those with low-income, these populations are underrepresented in DSP studies. The Flint Neuropathy Study is assessing glucose intolerance and DSP in a predominantly Black, low-income setting. Methods: Patients &amp;gt;40 years presenting to the Hurley Medical Center Outpatient Internal Medicine Residency Clinic in Flint, Michigan were enrolled. Demographics, clinical characteristics including medication use, anthropomorphic measurements, fasting lipids, fasting glucose, and Hemoglobin A1C were obtained. Glucose intolerance was defined using the 2021 ADA diagnosis and classification of diabetes mellitus criteria. DSP was defined using the Michigan Neuropathy Screening Instrument Questionnaire Index (MNSIQI) . Descriptive statistics were assessed using means and frequencies. Results: 81 participants (62% female, 57.5yrs (SD 8.7) . 67% Black, 53% Medicaid, 22% &amp;lt;high school education) have enrolled. 40 (49%) had a history of glucose intolerance, 4 (5%) denied a history of glucose intolerance despite a prior diagnosis, and 7 (9%) were diagnosed as glucose intolerant through study labs. (23%) reported a history of neuropathy. Mean MNSIQI score was 2.65 (SD 1.56) ; 46 (57%) had DSP. 28 (55%) participants with glucose intolerance had DSP. Among participants with a history of glucose intolerance and DSP, 16/21 (76%) were unaware they had DSP. 7/ (64%) participants who did not know they had glucose intolerance prior to participation had DSP. Conclusions: DSP is extremely common and underrecognized in this patient population with low incomes. Improving awareness of glucose intolerance and DSP is imperative to ensure appropriate foot care and reduce the risk of amputation. Disclosure A.Gagne: None. H.Marcus: None. T.Dawood: None. G.Bachuwa: None. M.Kvalsund: None. E.L.Feldman: None. L.Skolarus: None. B.C.Callaghan: None. M.Elafros: None. Funding NIH NINDS (5R25NS089450) ; NIH NCATS (UL1TR002240) ; NIH NIDDK (P30-DK-02926) ; NIH NIDDK (P30-DK089503)

THE ASSOCIATION OF DURATION OF TYPE 2 DIABETES MELLITUS WITH THE PREVALENCE OF PERIPHERAL DIABETIC NEUROPATHY

Background: Chronic complications of diabetes mellitus have a significant role in increased morbidity, mortality, disability, and health cost as the population increases every year. Promotive and preventive actions are needed to decrease the prevalence of peripheral diabetic neuropathy. The screening tool for peripheral diabetic neuropathy is Michigan Neuropathy Screening Instrument (MNSI), which consists questionnaire and physical examination. Objective: The purpose of this study was to understand the association of the duration of type 2 diabetes mellitus with the prevalence of peripheral diabetic neuropathy in the Outpatient Unit of Gotong Royong Hospital Surabaya. Method: A cross-sectional study was done using 50 patients in the Outpatient Unit of Gotong Royong Hospital Surabaya. The sampling technique used consecutive sampling with filling out the Michigan Neuropathy Screening Instrument (MNSI) questionnaire. The score of the MNSI questionnaire is analyzed using Chi-Square Test. Result: Among 50 subjects who participated in the study, most were women (78%). The prevalence of patients with peripheral diabetic neuropathy was 28% from all subjects. This chronic complication is divided into two groups based on the duration of diabetes mellitus type 2 with the prevalence of peripheral diabetic neuropathy with a duration of diabetes &lt;5 years (18,2%) and peripheral diabetic neuropathy with the duration of diabetes more than equal to five years old (35,7%). From the analysis with Chi-Square, we did not find a significant association between the duration of type 2 diabetes mellitus and peripheral diabetic neuropathy (p = 0.004). Conclusion: There was no statistically significant association between the duration of type 2 diabetes mellitus and the prevalence of peripheral diabetic neuropathy.

Diabetic peripheral neuropathy in diabetic patients attending an urban health and training centre.

Introduction:Diabetic neuropathy is a complication affecting almost 50% of the diabetic patients. Diabetic Peripheral Neuropathy (DPN) predominantly affects the hands and lower limbs. It leads to loss of protective sensation resulting in continuous injury to insensitive feet. The early detection of DPN using an objective screening test followed by its appropriate management is important as up to 50% of the patients may be asymptomatic.Objectives:To screen Diabetic patients attending an Urban Health and Training Centre of a medical college in Tamilnadu for Diabetic Peripheral Neuropathy. To assess the association between DPN and selected variables such as socio-demographic factors, glycaemic control, duration of diabetes, physical activity, body mass index, smoking and consumption of alcohol.Methods:The study was conducted among 204 diabetic patients attending an Urban Health and Training Centre. Participants were assessed using Michigan Neuropathy Screening Instrument (MNSI), which involves using a questionnaire followed by a physical examination.Results:Of the 204 patients, 58.8% were male. The mean age was 54.8 years (SD = 8.8 years). About 79.9% were employed of which 29.4% were skilled labourers. Mean duration of diabetes was 6.2 years (SD = 5.3 years). The proportion of diabetics who screened positive for Peripheral Neuropathy was 23% and 45.6% using MNSI questionnaire and examination, respectively. An age of 60 years and above was significantly associated with DPN (OR = 2.505, P value = 0.003). A duration of more than 4 years of diabetes was also significantly associated with DPN (OR = 1.872, P value = 0.02820).Conclusion:A high proportion of diabetics with peripheral neuropathy did not express symptoms specific for diabetics. Thus, a simple tool like MNSI would be useful in primary care settings to screen for peripheral neuropathy, and hence prevent disability”.

Dietary weight loss in people with severe obesity stabilizes neuropathy and improves symptomatology.

The aim of this study was to determine the effect of dietary weight loss on neuropathy outcomes in people with severe obesity. A prospective cohort study of participants attending a medical weight-management program was followed. Weight loss was achieved with meal replacement of 800 kcal/d for 12 weeks and then transitioning to 1,200 to 1,500 kcal/d. The coprimary outcomes were changes in intraepidermal nerve fiber density (IENFD) at the distal leg and proximal thigh. Secondary outcomes included nerve conduction studies, Michigan Neuropathy Screening Instrument questionnaire and exam, Quality of Life in Neurological Disorders, and quantitative sensory testing. Among 131 baseline participants, 72 (mean [SD] age: 50.1 [10.5] years, 51.4% female) completed 2 years of follow-up. Participants lost 12.4 (11.8) kg. All metabolic syndrome components improved with the exception of blood pressure. IENFD in the distal leg (0.4 [3.3], p = 0.29), and proximal thigh (0.3 [6.3], p = 0.74) did not significantly change. Improvements were observed on the Michigan Neuropathy Screening Instrument questionnaire, two Quality of Life in Neurological Disorders subdomains, and quantitative sensory testing cold threshold. Dietary weight loss was associated with improvements in all metabolic parameters except blood pressure, and both IENFD outcomes remained stable after 2 years. Given that natural history studies reveal decreases in IENFD over time, dietary weight loss may halt this progression, but randomized controlled trials are needed.

Translation, validation, and diagnostic accuracy of the Arabic version of the Michigan neuropathy screening instrument.

The Michigan Neuropathy Screening Instrument (MNSI) is used to screen patients for diabetic neuropathy (DNP). We aimed to translate the MNSI questionnaire into Arabic (MNSIq-Ar) and to assess the validity and diagnostic performance of the MNSI Arabic version (MNSI-Ar).Cronbach alpha α and the interclass correlation coefficient were used to measure the reliability and reproducibility of the MNSIq-Ar. The instrument's validity was assessed by Spearman correlation with the Utah Early Neuropathy Scale (UENS), the Modified Toronto Neuropathy Score (mTCNS), diabetic neuropathy symptoms (DNS), and sural nerve amplitude (SNA). The construct validity of the MNSI-Ar was assessed by its ability to differentiate the severity of DNP (using the Kruskal–Wallis test). The diagnostic performance was assessed through the receiver operator curve area.We recruited 89 participants (mean [SD] age, 50.8 [12.3] years; 48% men). The MNSIq-Ar showed an α of 0.81 and intraclass correlation coefficient = 0.94, and the correlation coefficients with UENS, mTCNS, DNS, and sural nerve amplitude were 0.67, 0.83, 0.73, and −0.49, respectively (all P < .0001). The MNSI-Ar was able to differentiate the different severities of DNP. The receiver operator curve area was 0.93 with a high sensitivity of 95.9% and 100% for probable and confirmed DNP, respectively.MNSI-Ar is a reliable and valid tool to screen for diabetic neuropathy in the Arabic language with a good diagnostic performance and high sensitivity.

Diabetic Polyneuropathy Early in Type 2 Diabetes Is Associated With Higher Incidence Rate of Cardiovascular Disease: Results From Two Danish Cohort Studies.

Symptoms indicative of diabetic polyneuropathy (DPN) early in type 2 diabetes may act as a marker for cardiovascular disease (CVD) and death. We linked data from two Danish type 2 diabetes cohorts, the Anglo-Danish-Dutch Study of Intensive Treatment in People With Screen-Detected Diabetes in Primary Care (ADDITION-Denmark) and the Danish Centre for Strategic Research in Type 2 Diabetes (DD2), to national health care registers. The Michigan Neuropathy Screening Instrument questionnaire (MNSIq) was completed at diabetes diagnosis in ADDITION-Denmark and at a median of 4.6 years after diagnosis of diabetes in DD2. An MNSIq score ≥4 was considered as indicative of DPN. Using Poisson regressions, we computed incidence rate ratios (IRRs) of CVD and all-cause mortality comparing MNSIq scores ≥4 with scores <4. Analyses were adjusted for a range of established CVD risk factors. In total, 1,445 (ADDITION-Denmark) and 5,028 (DD2) individuals were included in the study. Compared with MNSIq scores <4, MNSIq scores ≥4 were associated with higher incidence rate of CVD, with IRRs of 1.79 (95% CI 1.38-2.31) in ADDITION-Denmark, 1.57 (CI 1.27-1.94) in the DD2, and a combined IRR of 1.65 (CI 1.41-1.95) in a fixed-effect meta-analysis. MNSIq scores ≥4 did not associate with mortality; combined mortality rate ratio was 1.11 (CI 0.83-1.48). The MNSIq may be a tool to identify a subgroup within individuals with newly diagnosed type 2 diabetes with a high incidence rate of subsequent CVD. MNSIq scores ≥4, indicating DPN, were associated with a markedly higher incidence rate of CVD, beyond that conferred by established CVD risk factors.

The Interaction of Diabetic Peripheral Neuropathy and Carpal Tunnel Syndrome.

Diabetes mellitus (DM) increases the risk for carpal tunnel syndrome (CTS) and is associated with its own neuropathic complications. Diabetic peripheral neuropathy (DPN) is a common complication seen in diabetic patients. In this study, we examine the relationship between the severity of DPN and CTS. Type 2 diabetic and control patients (n = 292) were recruited at a clinic visit. The Michigan Neuropathy Screening Instrument (MNSI) questionnaire was used to collect data related to peripheral neuropathy. The MNSI scores were compared for patients with CTS with and without DM in univariable and multivariable analyses. χ2 analyses were performed to quantitatively measure the associations between peripheral neuropathy and the presence of CTS. Of the 292 patients, 41 had CTS, and 19 of these had both CTS and DM. Of the 138 diabetic patients, 85 had peripheral neuropathy. There was no association between a diagnosis of CTS and an MNSI score indicative of peripheral neuropathy. In the diabetic population, CTS was inversely associated with DPN (P = .017). The MNSI scores between diabetic and control patients with CTS were comparable. The severity of peripheral neuropathy in diabetic patients with and without CTS is comparable. Diabetic patients without peripheral neuropathy have an association with higher incidence of CTS in this study, suggesting that there are disparate mechanisms causing DPN and CTS. Nevertheless, diabetes and CTS are risk factors for developing the other, and future studies should further explore how DPN and CTS differ to tailor patient interventions based on their comorbidities.

PERIPHERAL NEUROPATHY AMONG PATIENTS WITH TYPE 2 DIABETES USING MICHIGAN NEUROPATHY SCREENING INSTRUMENT

Objective: To determine the frequency of peripheral neuropathy and associated factors among patients with type 2 diabetes mellitus (T2DM), attending a tertiary care hospital via Michigan Neuropathy Screening Instrument (MNSI). Methodology: This cross-sectional study was conducted in the department of endocrinology and metabolic dise­aes, Medical Teaching Institute, Lady Reading Hospital Peshawar, from March to December 2019. A total of 365 patients with T2DM were included in the study. All patients were evaluated for peripheral neuropathy using the two sets of MNSI (symptoms and examinations). Results: Mean age of the patients was 49.0±7.52 years. Mean body mass index (BMI) was 28.1±5.21 kg/m2, and mean glycated haemoglobin (HbA1c) was 10.1±1.56%. There wew 150 (41.10%) males and 215 (58.90) females. Based on the scoring of MNSI questionnaire, 239 (65.5%) had diabetic peripheral neuropathy (DPN) while using MNSI examination 252 (69.0%) had DPN. By combining both questionnaire and examination, DPN was present in 290 (79.5%) of the study participants. The factors associated with DPN after controlling for potential confounders were age of &gt; 50, high levels of total cholesterol (TC) and low density lipoproteins (LDL). Conclusion: The frequency of DPN was found to be higher in our study population; the burden being high among males. Age, TC and LDL were found to have significant association.