Vibration Perception Threshold Values Research Articles

Assessing the vibration perception threshold in a community sample of adult Ghanaians.

The vibration perception threshold (VPT) helps evaluate human somatosensory function and diagnose peripheral neuropathy. To optimize its use as a primary neurologic tool, it is imperative to establish its typical values in healthy subjects and assess the factors affecting its variability in an individual to ensure consistency in its application. Demographic data and a brief medical history were collected from 391 non-diabetic adults aged 30-80 at Kpone-on-Sea in Ghana. The VPT was measured at the tip of the big toe, the medial malleolus, the tip of the middle finger, and the head of the ulna of each participant using a Horwell Neurothesiometer. The variability of VPT was assessed vis-à-vis the following factors: gender, age, fasting plasma sugar and body mass index. The mean age of participants was 48.4 ± 0.7 years, and the female-to-male ratio was 1.46. The overall VPT values ranged from 5.74 ± 0.14 volts to 8.55 ± 0.18 volts in the lower limbs and 3.61 ± 0.06 volts to 5.00 ± 0.08 volts in the upper limbs. Age was found to be the only factor that could predict VPT for both the lower and upper limbs (P < 0.001). One-Way Analysis of Variance with Tukey's posthoc showed that the VPT in the feet was significantly higher than that in the hands. Generally, the VPT was high on proximal sites and low on distal sites indicating that the vibration sensation increased from proximal to distal direction. Therefore, distal areas should be used for VPT testing with a Neurothesiomer. Age was found to be the only factor that affected VPT variability. Hence, the practical application of VPT will require age-specific reference ranges to cater for older adults.

Prevalence and Risk Factors for Peripheral Neuropathy in Chinese Patients With Gout.

ObjectivePeripheral neuropathies (PNs) are a group of disorders that affect the peripheral nervous system. PN in gout has been scarcely described. This study is conducted to determine the prevalence and related risk factors of PN, as assessed by vibration perception threshold (VPT) in patients with gout.MethodsA total of 442 patients were included in the cross-sectional study. The VPT values were measured by using the Biothesiometer sensory quantitative tester on each patient. The VPT value of either limb higher than 15 V was considered abnormal and is considered to have PN. The univariate and multivariate logistic regression models were used to identify risk factors for PN in patients with gout.ResultsWe included 442 patients with gout, 97.5% men, 26.9% tophaceous gout, mean age 45.5 ± 15.2 years, and 7.4 ± 4.6 years of disease duration. The prevalence of PN in patients with gout was 11.1%. Patients in the abnormal VPT group were older, had a longer gout duration, and had significantly higher levels of waist circumference, waist-to-hip ratio, systolic blood pressure (SBP), and erythrocyte sedimentation rate (ESR), as compared to patients in the normal vibration group (P < 0.05). The univariate logistic regression analysis demonstrated that there was a significant association between abnormal VPT and age, duration of gout, SBP, C-reactive protein, ESR, presence of tophi, and estimated glomerular filtration rate (eGFR) in all the subjects (P < 0.05). The multivariate logistic regression analysis indicated that age (odds ratio, 1.094) and presence of tophi (odds ratio, 1.048) were independent risk factors for PN in patients with gout.ConclusionThe abnormal VPT was significantly correlated with age and presence of tophi in patients with gout and the VPT level may be useful as a screening tool for assessment of PN in gout.

Assessment and Evaluation of Diabetic Foot using Biothesiometry and Artificial Neural Networks

Introduction: Diabetes is a common disorder that is prevalent in the general population. As it advances, it causes a multitude of consequences, some of which are fatal. Diabetic Neuropathy (DN) is one such illness that causes nerve damage, and it is quickly recognised and diagnosed using a technique known as biothesiometry. Aim: To create an assessment tool based on an Artificial Neural Network (ANN) that evaluates diabetic foot based on Vibration Perception Threshold (VPT) values. Materials and Methods: This experimental and predictive study was done using VPT values for 696 controlled and diabetic groups selected by purposive sampling. The VPT was measured by a biothesiometre. A metal probe was placed under the foot of the person and the voltage was increased gradually from zero and the transition from no vibration to the point of vibration is marked as VPT. Average of three measurements were taken to calculate the VPT value of the given patient. This involves the VPT value which helps in the assessment of severity of the condition. The recorded data was fed as an input to the ANN model which predicted the average VPT value of the left and right foot. Furthermore, the ANN model was assessed my means of statistical measures and parameters. Results: The results of the study confirmed the correlation between the values of VPT acquired at different points of the foot and the coefficient for the left and right foot was found to be 0.99549 and 1.0000 respectively. Furthermore, the efficiency of the proposed ANN model was assessed using statistical measures like Mean Square Error (MSE), Mean Absolute Error (MAE), Square Sum Error (SSE) and Coefficient of determination (R2 ). The predicted values were very close to the experimental VPT results, and the correlation coefficient R are 0.99549 and 0.99975 for the left and right foots respectively, which shows the best settlement. Conclusion: The study concluded that VPT acquired from the foot of diabetic patients is useful in categorising the level of severity of DN. Furthermore, the results of ANN model proved that there exists a strong correlation between the average VPT values of left and right foot and those that are acquired from different points of the foot such as Great Toe, First metatarsal, Third metatarsal, Fifth metatarsal, In step and heel which concluded the study to be effective in the assessment and diagnosis of DN.

Serum albumin was negatively associated with diabetic peripheral neuropathy in\xa0Chinese\xa0population: a cross-sectional study

BackgroundPrevious studies that explored the relationship of serum albumin with diabetic peripheral neuropathy (DPN) have indicated inconsistent results. Thus, the present study aimed to evaluated the association between serum albumin and DPN, defined as vibration perception threshold (VPT) values ≥ 25 V and/or inability to feel the monofilament, in Chinese patients with type 2 diabetes mellitus (T2DM).Methods1465 T2DM patients aged ≥ 16 years, who completed the measurement of serum albumin and DPN screening between 2012 and 2015, were included in the cross-sectional study. Correlation and multivariate logistic regression analysis models were used to evaluate the possible relationship between serum albumin and DPN.ResultsPatients with higher quartiles of serum albumin had significantly lower VPT values and prevalence of DPN compared with those with lower quartiles (P for trend < 0.01), and there was an inverse relationship between serum albumin and VPT values and prevalence of DPN (all P < 0.01). Multivariate logistic regression analysis demonstrated that the risk of DPN was progressively decreased across serum albumin quartiles (P for trend < 0.01), and participants in the highest quartile of serum albumin were at a significantly decreased risk of DPN compared to those in the lowest quartile (odds rate: 0.311, 95% confidence intervals 0.134–0.724, P < 0.01). ROC analysis revealed that the optimal cutoff point of serum albumin for the prevalence of DPN was 39.95 g/L in patients with T2DM, with a sensitivity of 65.88% and a specificity of 66.7%.ConclusionsDecreased levels of serum albumin might be correlated with increased risk of DPN in Chinese patients with T2DM. Future longitudinal studies with large samples are warranted to confirm our findings, and elucidate putative mechanisms for the association.

Vibration Perception Threshold and Related Factors for Balance Assessment in Patients with Type 2 Diabetes Mellitus.

Diabetic peripheral neuropathy (DPN) is a common complication of type 2 diabetes mellitus (DM). DPN causes a decrease in proprioception, which could reduce balance ability. We investigated the association of impaired vibration sense, based on vibration perception threshold (VPT), with assessments of balance and other factors affecting balance impairment and fear of falling in patients with type 2 DM. Sixty-three patients with DM aged >50 years were categorized as having normal vibration sense (NVS; n = 34) or impaired vibration sense (IVS; n = 29) according to a VPT value of 8.9 μm. The following parameters were evaluated for all patients: postural steadiness through the fall index using posturography, functional balance through the Berg Balance Scale (BBS), the Timed Up and Go test (TUG), and fear of falling through the Falls Efficacy Scale-International (FES-I). The IVS group showed a significantly greater balance impairment in fall index, BBS, and TUG, as well as greater fear of falling on the FES-I than the NVS group. The linear regression analysis showed that the fall index was associated only with the VPT, whereas BBS, TUG, and FES-I were associated with the VPT, age, and/or lower extremity muscle strength. VPT, age, and/or muscle strength were identified as predictors of balance and fear of falling in patients with type 2 DM. Therefore, along with age and lower extremity strength, the VPT can be useful for balance assessment in patients with type 2 DM.

Quantitative vibration perception threshold in assessing diabetic polyneuropathy: Should the cut-off value be adjusted for Chinese individuals with type2 diabetes?

Aims/IntroductionTo examine the performance and identify the optimal threshold of vibration perception threshold (VPT) for diagnosing diabetic polyneuropathy (DPN) in a Chinese population according to multiple definitions of DPN as gold standards.Materials and MethodsVPT was determined in 421 Chinese individuals with type 2 diabetes, who simultaneously completed a questionnaire of neuropathic symptoms, and underwent the assessment of signs of peripheral neuropathy and electromyography tests. Three definitions of DPN (i.e., clinician‐diagnosed DPN, abnormal nerve conduction and confirmed DPN) were taken as reference gold standards.ResultsVibration perception threshold was a specific measure for all three groups of DPN outcomes, with the highest specificity noted for clinician‐diagnosed DPN (85.1%). The specificity for abnormal nerve conduction and confirmed DPN was 77.0 and 76.6%, respectively. The sensitivity of VPT was 67.0% for clinician‐diagnosed DPN, 66.5% for abnormal nerve conduction and 67.2% for confirmed DPN. The optimal cut‐off threshold for abnormal nerve conduction, as well as confirmed DPN, was VPT >14.9 V. The specificity and sensitivity of VPT >14.9 V as the cut‐off value for clinician‐diagnosed DPN were 85.6 and 66.2%, respectively. When taking clinician‐diagnosed DPN as the gold standard, the performance of VPT for diagnosing DPN was best with an area under the curve value of 0.804.ConclusionsVPT measured using the neurothesiometer had relatively high specificity and best performance for diagnosing DPN when clinician‐diagnosed DPN rather than abnormal nerve conduction was taken as the gold standard in a Chinese population. A VPT value of ≥15 V might be equally applicable for diagnosing DPN in a Chinese population.

Knowledge, attitude and practice of foot care in diabetes patients with foot at risk attending diabetology department of a tertiary care hospital

Background: The current study was undertaken to assess the knowledge, attitude and practice (KAP) of foot care among diabetes patients with foot at risk, to evaluate the impact of counselling in terms of KAP score, VPT (vibration perception threshold) value, foot examination status and other clinical parameter, to assess the severity of peripheral neuropathy in diabetes patients based on VPT value and to assess the prevalence of peripheral neuropathy among men and women.Methods: A prospective cross-sectional and interventional study was conducted in the diabetology department of a tertiary care hospital in South India. A total of 100 diabetes patients with foot at risk were selected for the study. A questionnaire was used to assess the knowledge, attitude and practice of foot care among diabetes patients with foot at risk. The questionnaire consists of total 24 questions. Their knowledge, attitude and practice were classified as good, satisfactory and poor depending upon the score. For the KAP, if score is ≥70% it was regarded as good, 50-69% as satisfactory and &lt;50% as poor.Results: The study assessed that among 100 patients, 6% of the participants had good knowledge before counselling and after counselling, 46% had satisfactory level of knowledge and 43% had good knowledge. Most of the patients had a good attitude towards foot care before and after counselling. Only 1% of patients were in good practice before counselling and after counselling 62% of the patients had satisfactory practice and 25% had good practice. The study revealed that about 53% had a VPT value of 26-50 V before providing counselling and after counselling about 43% of the participants VPT became 26-50 V. The study also showed that the prevalence of peripheral neuropathy according to VPT value is more in males than females.Conclusions: Poor knowledge and poor practice were observed among the diabetes patients with foot at risk who had attended the diabetology department. Poor knowledge and practice are the major reason for the amputation of limb as the people are unaware of their foot care. Thus, by providing proper education regarding foot care, the foot complications can be improved and there by the amputation rate can be reduced to an extent.

Association between Circulating B-Type Natriuretic Peptide and Diabetic Peripheral Neuropathy: A Cross-Sectional Study of a Chinese Type 2 Diabetic Population.

Cardiovascular disease which is associated with cardiac dysfunction, usually measured with circulating levels of B-type natriuretic peptide (BNP), has been associated with incidence and progression of diabetic peripheral neuropathy (DPN). The potential relationship of circulating physiological levels of BNP with DPN, however, has not been reported. Circulating levels of BNP were measured in 258 patients with type 2 diabetes mellitus (T2DM), and participants were divided into a DPN group (n = 61) and no DPN group (n = 197). The relationship between circulating physiological levels of BNP and DPN and other parameters was analyzed. Circulating levels of BNP were significantly elevated in T2DM patients with DPN compared to those without (P = 0.001). Circulating levels of BNP were significantly and positively associated with systolic blood pressure (P = 0.035), neutrophil-to-lymphocyte ratio (P = 0.007), creatinine (P = 0.030), vibration perception threshold values (P = 0.021), and the prevalence of diabetic foot ulceration (P = 0.039), peripheral arterial disease (P = 0.013), DPN (P = 0.032), and diabetic nephropathy (P = 0.020) and negatively with lymphocyte count (P = 0.003) and ankle-brachial index (P = 0.038), irrespective of age, sex, and body mass index. Moreover, circulating levels of BNP was an independent decisive factor for the presence of DPN after multivariate adjustment (odds ratio, 1.044; 95% confidence interval, 1.006-1.084; P = 0.024). Additionally, the higher quartiles of circulating BNP were related significantly to an increased risk of DPN compared to the lowest quartile (P = 0.003). Last but most importantly, the analysis of receiver operating characteristic curves revealed that the best cutoff value for circulating levels of BNP to predict DPN was 15.18 pg/mL (sensitivity 78.7% and specificity 48.2%). These findings suggest that high circulating physiological levels of BNP may be associated with the development of DPN and may be a potential biomarker for DPN in patients with T2DM.

Vibration threshold in non-diabetic subjects.

Measuring vibration perception threshold (VPT) accurately classifies and quantifies the severity of loss of vibration perception. A biothesiometer (Bio-thesiometer®; Bio Medical Instrument Co, Ohio, USA) appears to be the most suitable tool to determine VPT due to its low inter-rater variability and low occurence of adaption to the sensation. Different VPT values for a biothesiometer have been described, however, specification on age, height and different measurement locations is currently lacking. The objective of our study was to identify determinants of vibration perception in non-diabetic subjects, in order to provide individualized normal values of VPTs for clinical practice. Measurements of the vibration perception were performed on the big toes, insteps, lateral malleoli, and wrists. A total of 205 healthy subjects were included (108 (52.7%) males) with a median [interquartile range] age of 59 [51;64] (range 21-80) years. Mean height was 174.45 ± 9.20 cm and mean weight was 82.94 ± 14.84 kg, resulting in a mean BMI of 27.19 ± 4.00 kg/m2. In stepwise forward linear regression analyses, age (st. β = 0.51, p < 0.001) and height (st. β = 0.43, p < 0.001) were found to be the independent unmodifiable determinants of the VPT at the big toe. Regression coefficients for quantiles of the determinants age and height were incorporated in the corresponding regression equations. This study provides equations to calculate age- and height-specific normal values for VPT that can be used in clinical practice and in large research studies.

The impact on large fibre function and small fibre function in patients with type 2 diabetes on benfotiamine therapy

Diabetes mellitus (DM) is the leading cause of neuropathy worldwide. Based on the data from several studies, sensorimotor polyneuropathy (diffuse and symmetric neuropathy) will develop within 10 years of the onset of DM in 40 % to 50 % of patients with type 1 and type 2 DM. In patients with type 2 DM, target blood glucose levels are associated with a reduced incidence of neuropathy. Objective — to study the correlation between the stage of diabetic peripheral polyneuropathy in type 2 diabetic patients, and the effects and efficacy of benfotiamine as transketolase activator. Materials and methods. In this study, 190 patients with type 2 DM were screened for DPN. DPN was confirmed in 105 patients displaying both clinical manifestations of neuropathy with a positive Diabetic Neuropathy Symptom (DNS) score and increased vibration perception threshold (VPT) on a biotensiometer. Based on the above stated criteria patients were divided into 4 groups: 1 — with positive DNS score, positive 10 g monofilament test score, VPT between 16—25 volts; 2 — with positive DNS score, positive 10 g monofilament test score, VPT between 26—35 volts; 3 — with positive DNS score, positive 10 g monofilament test score and VPT between 35—40 volts; 4 — control group with positive DNS score, negative 10 g monofilament test score and normal VPT value (n = 25 (23 %); 20 females and 5 males). The first 3 groups received benfotiamine 300 mg daily for 6 weeks, the control group was benfothiamine naïve. All the groups continued their antidiabetic medication. Results and discussion. The diabetic neuropathy score and vibration perception threshold was assessed in 105 patients (84 females and 21 males) with type 2 DM, before starting of benfotiamine 300 mg daily and after 6 weeks of therapy. Results of DNS: differences between group 3 and both group 1 and 2 were significant, but not between group 1 and 2. Patients in group 1 (n = 24), in females (n = 18) the DNS varied from 1—2, and in males (n = 6) the DNS varied from 1—3. After the 6 weeks,DNS score decreased in both females and males i.e. 1—1.25 and 1—2.5 correspondingly. Conclusions. The role of benfotiamine in clinical practice has been demonstrated in many clinical trials with variable trial design, patient groups and history of diabetes. In our study we found that patients with mild neuropathy and vibration perception threshold of 16—25 volts showed a reduction in VPT of up to 16 %, and the patients with moderate neuropathy and reduced vibration perception threshold of 26—35 volts were the ones who benefitted the most from benfotiamine therapy. Benfotiamine activates transketolase and thus helps in the reduction of AGEs formation and associated sugar induced metabolic stress.

The Semmes -Weinstein monofilament examination as a single effective screening tool in the evaluation of diabetic peripheral neuropathy when compared to vibration perception threshold

Background: Diabetic peripheral neuropathy (DPN) leads to foot ulcers and non-traumatic amputation, which is a major cause for morbidity and disability in India. At present, no precise pharmacological agent has confirmed efficacy in preventing disease progression or reversing neuropathy symptoms. Clinically, it is crucial to find an effective screening tool for diagnosing DPN. Although vibration perception threshold (VPT) testing and Semmes-Weinstein monofilament examination (SWME) are considered as combined diagnostic tools to diagnose DPN, a single effective screening method to identify DPN is quite unavailable in India. Aim and Objective: This study aimed to evaluate the usefulness of the SWME in DPN when compared to VPT. Materials and Methods: Fifty control subjects and 50 DPN subjects aged between 30 and 70 years were included in the study. The anthropometric parameters, fasting blood sugar (FBS), duration of diabetes mellitus, VPT, and the SWME were recorded. Results: There was a significant difference in body mass index, FBS, VPT, and SWME in DPN subjects (P < 0.0001) when compared with control subjects. The increased duration of DPN increases the VPT (0.805) values and decreases the SWME (−0.488) values. In the kappa test, the measure of agreement between SWME and VPT was significant (0.960), meaning both tests are equally effective in screening DPN subjects. Conclusion: The present findings show that SWME can be used as a single effective screening tool in diagnosing DPN when compared with VPT. This can reduce the risk of ulceration and lower extremity amputation in DPN subjects at the earliest.

Association between serum uric acid and large-nerve fiber dysfunction in type 2 diabetes: a cross-sectional study.

BackgroundLarge-nerve fiber dysfunction, as assessed by vibration perception threshold (VPT) predicts risks of ulceration, amputation, and mortality in diabetes. Serum uric acid (UA) is closely associated with various metabolic disorders, especially diabetes. Thus, we sought to investigate the clinical relevance of UA to large-nerve fiber dysfunction, among patients with type 2 diabetes (T2D).MethodsMedical records of consecutive patients with T2D who were admitted to Beijing Friendship Hospital Pinggu Campus between May 2014 and December 2016 were collected. Data for the 824 eligible patients included in the final analysis were extracted using a structured form. A VPT value ≥15 in either foot was defined as abnormal. We compared the clinical characteristics between patients with abnormal VPT and those with normal VPT (VPT value <15 in both feet) in the overall population and in gender subgroups. Logistic regression analysis was performed to explore the association of abnormal VPT with UA level. One-way analysis of variance was used to compare VPT values across four UA quartiles.ResultsUA levels were significantly lower in T2D patients with abnormal VPT than in those with normal VPT (294.5 ± 84.0 vs. 314.9 ± 92.8 μmol/L, P < 0.01), especially among male patients (311.7 ± 85.2 vs. 336.9 ± 89.6 μmol/L, P < 0.01). From the logistic regression analysis, hyperuricemia (males >420 μmol/L; females >360 μmol/L) was associated with a reduced risk of abnormal VPT (odds ratio [OR], 0.60; 95% confidence interval [CI], 0.39–0.91; P < 0.05). This association was robust in male patients (OR, 0.43; 95% CI, 0.24–0.76; P < 0.01) but not in female patients (OR, 0.92; 95% CI, 0.47–1.82; P = 0.816), even after adjustment for confounding factors. For the younger male subgroup (age <65 years), VPT values decreased as the UA level increased (P for trend = 0.002), but this trend was not significant in older male subgroup (age ≥65 years; P for trend = 0.400).ConclusionsLow serum UA levels showed a significant association with an increased risk of large-nerve fiber dysfunction in male patients with T2D, but not in female patients with T2D. In addition, in only the younger subgroup of male patients (<65 years), lower levels of UA also correlated with higher VPT values.

Vibration Perception Threshold Values and Clinical Symptoms of Diabetic Peripheral Neuropathy

Vibration Perception Threshold Values and Clinical Symptoms of Diabetic Peripheral Neuropathy

Neutrophil-to-lymphocyte ratio is associated with diabetic peripheral neuropathy in type 2 diabetes patients.

Diabetic peripheral neuropathy (DPN) had been demonstrated as a chronic inflammation state and one of the most common complications of type 2 diabetes mellitus (T2DM). Neutrophil-to-lymphocyte ratio (NLR) is a novel marker to reflect many kinds of chronic inflammation disease including diabetes. We aim to evaluate the association between NLR and DPN and to determine whether NLR could be a new indicator of DPN in type 2 diabetes patients. We retrospect the consecutive medical files of T2DM patients. Nerve conduction velocity (NCV), vibration perception threshold (VPT) and the data for complete blood count were recorded. Patients were divided into tertiles based on admission NLR values. Clinical parameters were firstly compared among groups. Then, logistic regression and ROC analysis were performed. Percentages of DPN were 42.60%, 54.97% and 65.50%, in the low, middle and high tertile, respectively (n=72, 94 and 112, p<0.05). VPT values were 13.75±7.97, 15.01±9.60 and 16.78±10.92, respectively, (p<0.05). NCV in different nerves decreased with the increase of NLR (p<0.05). After adjusting potential related factors, NLR was still related to status of DPN in the logistic regression (r=1.743, p=0.001). Area under ROC was 0.619 (p<0.001). The present study showed that T2DM patients with higher NLR levels might be more likely to develop peripheral neuropathy complication. NLR levels grow with the increase of NCV and VPT results. As a predictor of DPN, NLR could be used in clinical practice to help doctors understand the level of DPN progression.

Association of SUDOSCAN Values with Vibration Perception Threshold in Chinese Patients with Type 2 Diabetes Mellitus.

Aims/Introduction SUDOSCAN has been proved to be an efficient method in detecting diabetic microvascular complications. In this study, we determine to detect the possible relationship between vibration perception threshold (VPT) and cardiac autonomic neuropathy (CAN) values produced by SUDOSCAN. Materials and Methods A total of 920 Chinese patients with T2DM were enrolled in the study. Spearman correlation analysis and multivariate regression analysis were performed to determine the relation between CAN and VPT values. Mean VPT values across the CAN value tertiles were analyzed stratified by HbA1c status. Results In the study, we discovered a relatively high correlation between CAN value and both VPT values from dorsal feet and toes. Multivariate regression analyses also showed a significant relation between VPT and CAN values after adjusting all covariates. The mean value of VPT decreased across the SUDOSCAN-CAN value quartiles in both groups, and it was higher in patients with HbA1C > 9% than in patients with HbA1C < 9% across all quartiles of the SUDOSCAN-CAN except for the VPT mean in the low quartile of the SUDOSCAN-CAN value. Conclusions All these results suggested that SUDOSCAN-CAN result was associated with VPT value which indicated a probable link between VPT value and cardiovascular autonomic dysfunction.

Sudoscan is an effective screening method for asymptomatic diabetic neuropathy in Chinese type 2 diabetes mellitus patients.

Aims/IntroductionThe aim of the present study was to use the sudomotor function test, Sudoscan, as a screening method for the evaluation of asymptomatic diabetic distal symmetric polyneuropathy in Chinese type 2 diabetes patients. As a result, more attention could be paid to those asymptomatic patients who could be easily neglected and underdiagnosed in everyday clinic.Materials and MethodsA total of 394 Chinese type 2 diabetes patients were enrolled and tested for symptoms and clinical signs of neuropathy using the Neurological Symptom Score, Neuropathy Disability Score, and vibration perception threshold. Sudoscan was carried out, and the results were collected as the measurement of the electrochemical skin conductance of both hands and feet.ResultsIn the present study, we found that the abnormal rate of Sudoscan results in patients with asymptomatic neuropathy was higher than those without neuropathy and those with symptomatic neuropathy. This study also showed that lower electrochemical skin conductance at the feet was significantly associated with increasing symptoms, Neurological Symptom Score (r = −0.124, P < 0.05), Neuropathy Disability Score (r = −0.3, P < 0.01) and vibration perception threshold value (r = −0.18, P < 0.05). Logistic analysis showed that age (odds ratio 1.042, 95% confidence interval 1.014−1.071, P < 0.05) and feet electrochemical skin conductance levels (odds ratio 0.98, 95% confidence interval 0.962–0.993, P < 0.01) were independently associated with diabetic distal symmetric polyneuropathy.ConclusionsSudoscan might be a promising tool to screen asymptomatic diabetic distal symmetric polyneuropathy in Chinese patients with type 2 diabetes mellitus.

Diagnostic Accuracy of Clinical Methods for Detection of Diabetic Sensory Neuropathy.

To determine the accuracy of clinical methods for detection of sensory neuropathy as compared to biothesiometry. Cross-sectional analytical study. 1 Mountain Medical Battalion, Azad Kashmir, from October 2013 to September 2014. Patients with type 2 diabetes were enrolled by convenience sampling. Exclusion criteria included other identifiable causes of neuropathy, extensive ulceration of feet, amputated feet, those on treatment for neuropathy and unwilling patients. Average of 3 vibration perception threshold values measured with a biothesiometer on distal hallux was calculated. Ten gm monofilament was used to examine touch sensation over dorsal surfaces of great toes. Vibration sensation was checked over the tips of great toes using 128Hz tuning fork. Ankle jerks were checked bilaterally. Neuropathy (vibration perception threshold > 25 volts) was present in 34 (21.12%) out of 161 patients and 93 (57.76%) were symptomatic. Measures of diagnostic accuracy for monofilament, tuning fork and ankle jerks were: sensitivity 41.18%, 55.88% and 64.71%; specificity 92.91%, 93.70% and 80.31%; positive predictive value (PPV) 60.87%, 70.37% and 46.81%; negative predictive value (NPV) 85.51%, 88.81% and 89.47%; and, diagnostic accuracy 81.99%, 85.71% and 77.02%, respectively. Values for any 1 positive sign, any 2 positive signs or all 3 positive signs were: sensitivity 35.29%, 14.71% and 32.35%; specificity 81.89%, 93.70% and 99.21%; PPV 34.29%, 38.46% and 91.67%; NPV 82.54%, 80.41% and 84.56%; and, diagnostic accuracy 72.05%, 77.02% and 85.09%, respectively. Clinical methods are high accurate and specific diagnosis in picking up symmetric sensory neuropathy in patients with type 2 diabetes, particularly when multiple signs are combined.

Elevated Vibration Perception Thresholds in CIDP Patients Indicate More Severe Neuropathy and Lower Treatment Response Rates.

IntroductionVibration perception threshold (VPT) examination using a neurothesiometer provides objective, sensitive and specific information, and has been utilized mainly in patients with diabetic polyneropathy.ObjectivesExplore the utility of VPT examination in CIDP patients.MethodsCIDP subjects attending the Neuromuscular clinic between 01/2013 and 12/2014 were evaluated. Demographic data, clinical history, physical examination, VPT values, and electrophysiologic data from their charts were extracted.Results70 charts were reviewed. 55 CIDP patients had elevated VPT, associated with higher frequency of abnormal sensory testing for various modalities (92.7% vs. 46.7%, p<0.0001), lower sensory and motor amplitudes and reduced conduction velocities on nerve conduction studies, and lower treatment response rates (54% vs. 93%, p = 0.01).ConclusionVPT examination is a simple tool, which is a reliable and sensitive measure not only for diabetic neuropathy, but also for CIDP. Moreover, in CIDP, elevated VPT values are also associated with lower treatment response rates.

Reproducibility of vibration perception threshold values in children and adolescents with type 1 diabetes mellitus and associated factors

AimsTo define the reproducibility of vibration perception thresholds (VPTs) and the possible associated factors, as an early index of peripheral diabetic neuropathy (PDN) in type 1 diabetes mellitus (T1DM) children and adolescents. MethodsA single examiner studied 118 T1DM subjects (aged 13.5±3.4 years) and 79 controls (aged 12.0±3.07 years). Glycaemic control was assessed with HbA1c levels. VPT was measured twice on upper and lower limbs, using a Biothesiometer. Concordance between the two VPT measurements was evaluated using the Cohen's Weighted Kappa statistic (Kappa=0.41–0.60→moderate concordance, Kappa=0.61–0.80→substantial concordance). ResultsT1DM children had significantly higher VPTs than controls at all sites (p=0.001), but with lower Kappa values (0.64–0.70). VPT values increased in parallel with HbA1c (a.<8%, b. 8–9.5%, c.>9.5%) and T1DM duration (a.<5 years, b.5.1–10, c.>10 years). However, Kappa values were lower in the groups with the poorest control (HbA1c>9.5%) (Kappa=0.54–0.76) or the longest T1DM duration (>10 years) (Kappa=0.49–0.71). Although VPTs increased with stature and male gender, no effect on VPT reproducibility was observed. However, obesity was associated with lower VPT values and poorer concordance. ConclusionsThese findings suggest that the reproducibility of VPTs is lower in the high-risk patients for early subclinical PDN development, who need a regular follow-up.

Vibrating Perception Threshold and Body Mass Index Are Associated with Abnormal Foot Plantar Pressure in Type 2 Diabetes Outpatients

This study investigated the influencing factors of foot plantar pressure and attempted to find practical indicators to predict abnormal foot pressure in patients with type 2 diabetes mellitus (T2DM). Vibration perception threshold (VPT) and foot plantar pressure in 1,126 T2DM outpatients were examined. Patients were assigned to Group A (n=599), Group B (n=312), and Group C (n=215) according to VPT values and to Group I (n=555), Group II (n=436), and Group III (n=135) based on body mass index (BMI). The clinical characteristics and pressure-time integral (PTI) were compared among the three groups, and the associated factors of the total PTI in the entire foot (T-PTI) were analyzed. PTI of Group C in heel medial and heel lateral was significantly higher than that of Group A (all P<0.01). PTI of Group B in the right fifth metatarsal and heel medial was significantly higher than that of Group A (all P<0.05). T-PTI of Group C was significantly higher than those of Groups A and B, and that of Group B was higher than that of Group A (all P<0.01). PTI of Groups II and III in the second, third, and fourth metatarsal, midfoot, heel medial, and heel lateral was significantly higher than that of Group I (all P<0.05). T-PTI of Groups II and III was significantly higher than that of Group I (all P<0.01). Pearson correlation analysis showed that T-PTI was positively associated with age, VPT, waist circumference, waist-to-hip ratio, and BMI (P<0.05). In multiple stepwise regression analysis, VPT (P=0.004) and BMI (P=0.000) were independent risk factors of T-PTI, and each 1 unit increase in BMI increased the T-PTI by 5.962 kPa•s. Receiver operator characteristic curve analysis further revealed that the optimal cutpoint of VPT and BMI to predict the abnormal PTI was 21 V (odds ratio=2.33, 95% confidence interval 1.67-3.25) and 24.9 kg/m(2) (odds ratio=2.12, 95% confidence interval 1.55-2.90), respectively. Having a VPT higher than 21 V and a BMI above 24.9 kg/m(2) increases the risk of excessive foot plantar pressure in Chinese T2DM.