Reliability of diabetic neuropathy symptom and diabetic neuropathy examination scoring system for the diagnosis of diabetic peripheral neuropathy in type 2 diabetes mellitus patients

Background: This study aims to evaluate the reliability of the Diabetic Neuropathy Examination Score (DNE), 10-g Semmes-Weinstein Monofilament Examination and Quantitative Sensory Testing by Vibration Perception Threshold (VPT) in the diagnosis of diabetic polyneuropathy and seek a cost effective and reliable screening method in diabetic OPD and IPD against the gold standard of NCV.Methods: This study was carried out in 50 confirmed type 2 diabetic patients matched for age, sex, duration and ABI >0.9 irrespective of the presenting complaints. Patients with either limb amputation, other reasons for peripheral neuropathy, ABI <0.9, critical and comatose were excluded. A complete neurological assessment using a symptom questionnaire, Semmes Weinstein monofilament, vibration and thermal threshold perception analyzer was done and recorded. A score was given out of 20. The patients were retrograde subjected to NCV by a blinded technician and the readings were then compared to the scores.Results: The level of significance between the total neuropathy score and the presence of neuropathy (by NCV) was very significant (p<0.0001) with an association of 0.932. In patients with a mean total neuropathy score of 3.28,10.80 and 15.37, there was no, mild and severe levels of neuropathy in NCV respectively.Conclusions: There is correlation between the total neurological scores and NCV. Therefore, it can be used to screen all diabetic patients for earliest signs of diabetic neuropathy with sustainable results.

Risk Determinants of Peripheral Neuropathy in Patients with Type II Diabetes Mellitus Attending Follow-Up Clinics at Universiti Kebangsaan Malaysia Medical Center (UKMMC): A Cross-Sectional Study

Peripheral neuropathy is highly associated with foot complications among diabetics. This study aimed to identify risk factors associated with the development of peripheral neuropathy in diabetic patients and their association with degree of severity of peripheral neuropathy. A cross-sectional study was conducted in follow-up clinics at the Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Malaysia involving 72 diabetic patients and 19 controls. Exclusion criteria were those with amputated limbs, gross foot deformity and existing peripheral neuropathy. Controls were non diabetics who walked normally, had no history of foot problem and attended the clinic as subjects’ companion. Quantitative assessment of neuropathy was done using Semmes-Weinstein monofilament. Neuropathy Disability Score (NDS) were used to quantify severity of diabetic neuropathy. Spearman’s Rank test and Mann-Whitney test were used to determine correlation between variables and their differences. Logistic regression analysis was used to determine risk factors associated with peripheral neuropathy. The mean HbA1c among diabetics was 8.6% + 4.1, and mean NDS was 7.0 + 6.0. A total of 79.1% demonstrated various level of neuropathy with presence of callus was associated with higher NDS scores. Older age (P=0.02), body weight (P=0.03), HbA1c (P=0.005) and duration of diabetes (P <0.005) showed positive correlation with NDS. Proper foot care program for diabetics should include recognition of the callus, with special emphasis given to those with heavier weight and increasing age.

Umbral de sensibilidad de los nervios periféricos de la mano en pacientes con diabetes tipo II / Sensitivity theshold of peripheral nerves of hand in patients with diabetes type II

Las neuropatías periféricas en mano de los pacientes con diabetes tipo II son poco estudiadas por lo que esta investigación de tipo descriptivo se buscó establecer su manifestación mediante una prueba de sensibilidad con monofilamentos de Semmes-Weinstein (SWME) realizada a 66 pacientes que asisten a la Clínica de Diabetes del Hospital Militar Central de Bogotá (HOSMIC), en un período de 4 meses. Se tuvo en cuenta la edad, el género y la dominancia, las que se relacionaron con el umbral sensitivo en los territorios autónomos de los nervios radial, mediano y cubital. Las 132 manos evaluadas el mayor porcentaje presentó disminución del tacto ligero, así: 43% nervio radial, 36% nervio mediano y 42% nervio cubital. La disminución de la sensación protectiva mostró que el nervio radial se comprometió en el 29%, el nervio mediano en el 21% y el cubital en el 14%. Las mujeres tienen el mayor porcentaje de normalidad en el tacto con 42%, mientras que los hombres lo presentaron en la disminución del tacto ligero en un 43%. En cuanto a edad, el mayor compromiso se presentó en usuarios mayores de 70 años en un 26% y no hubo notoria diferencia entre la sensibilidad de la mano dominante y la no dominante.

Peripheral neuropathies in hand of patients with diabetes are poorly studied so this research is a descriptive cross, find their expression through a sensitivity test to Semmes-Weinstein monofilament (SWME) performed to 66 patients attending to the Diabetes Clinic of the Central Military Hospital in Bogotá (HOSMIC), over a period of 4 months. The variables that were considered were age, gender and dominance which were related to sensory findings in the autonomous territories of the radial nerve, median and ulnar. It was established that 132 of the hands evaluated provided the highest percentage decrease in light touch, and 43% radial nerve, median nerve 36% and 42% ulnar nerve. The decrease of the protective sensation showed that the radial nerve was committed at 29%, the median nerve in 21% and the ulnar in 14%. It was concluded that women have the highest percentage of normalcy in touch with 42% while men showed a decrease in light touch by 43%. Regarding age, the greater was present in users over 70 years by 26% and there was no noticeable difference between the sensitivity of the dominant hand and non-dominant.

Sensory Thresholds of Normal Human Feet Using Semmes-Weinstein Monofilament

OBJECTIVE: To obtain the sensory thresholds of the feet from healthy adult using Semmes-Weinstein monofilaments. METHOD: Twenty male and twenty female volunteers aging from 24 to 38 years old were selected. There were no known medical conditions associated with decreased foot sensation and history of previous injury to the foot. The subjects were blindfolded with the leg resting on a chair as 14 plantar and 5 dorsal locations were tested on each foot. Each site on the foot had the Semmes-Weinstein monofilaments applied to it first, in an order of increasing stiffness, then repeated in decreasing order. A positive threshold response was recorded when the subject could feel the filament and could accurately locate where on the foot the stimulus had been applied. RESULTS: The mean sensitivity for all sites was 3.41+/-0.17. Sensation in the plantar surface of greater toe, 5th toe, arch, and dorsal surface of 1st web space, 3rd toe at the metatarsophalangeal joint level, 5th metatarsal head were the most sensitive. The least sensitive regions were the heel pad, lateral plantar midfoot, and medial and lateral heel. CONCLUSION: Normal data of sensory threshold using Semmes-Weinstein monofilament could be used for the early detection of peripheral neuropathy or loss of protective sensation.

Improvement of diabetic peripheral neuropathy using monochromatic infrared energy / 中华物理医学与康复杂志

Objective To observe the effect of monochromatic infrared energy(MIRE)on diabetic periphe- ral neuropathy(DPN).Methods Seventy-four subjects with diabetic peripheral neuropathy who were tested by Semmes-Weinstein monofilaments(SWM)were randomized into 2 groups:a conventional management group and a conventional management plus MIRE group.Then the patients'sensory function and other DPN symptoms were evalu- ated by the SWME and the score of Michigan Neuropathy Screening Instrument.Results After treatments,there was a decrease(P＜0.01)in the number of the sites insensitive to SWME(grade 5.07),and MNSI scores were sig- nificantly decreased(P＜0.01).The MIRE management was more effective than conventional management.Con- clusion Monochromatic infrared energy is perhaps a safe,non-pharmaceutical and non-invasive method for the treat- ment of diabetic peripheral neuropathy.

Nerve Conduction Study Findings and Risk Category of Diabetic Foot Screening Test

OBJECTIVE: To assess the correlation between the risk categories of diabetic foot screening test by 5.07 Semmes- Weinstein monofilament and the findings of standard nerve conduction studies of upper and lower extremities. METHOD: We studied 74 patients who were consulted to our department to rule out the diabetic neuropathy. We classified the patients to 4 risk groups by foot screening test using 5.07 Sememes-Weinstein monofilament, and performed the standard nerve conduction studies of upper and lower extremities. The risk categories of foot screening tests were compared to the findings of the nerve conduction studies. RESULTS: When the risk category becomes higher, there were more delay in latencies (motor and sensory potentials of median and ulnar nerve, sensory potentials of sural and superficial peroneal nerve, median and peroneal F-wave), slower conduction velocities (median, ulnar, peroneal, posterior tibial nerve) and lower amplitudes (motor and sensory potentials of media and ulnar nerve, peroneal and posterior tibial nerve, sural nerve) (p<0.05). Except for the amplitude of ulnar nerve and the latencies of peroneal and ulnar nerve, there were significant differences in the nerve conduction study data between the risk group 3 and the risk group 0 (p<0.05). CONCLUSION: We confirmed that the risk category of diabetic foot screening test by Semmes-Weinstein monofilament can meaningfully reflect the severity of diabetic neuropathy. We also suggest that it is necessary to pay attention to the nerve conduction study in the patients with history of foot ulcer.

Foot Screening Tests with Semmes-Weinstein Monofilament in Diabetic Inpatients

OBJECTIVE: To determine the prevalence of each risk category for diabetic foot ulcer by foot screening test with Semmes-Weinstein monofilament and to evaluate the correlation of the risk category with clinical data in diabetic inpatients. METHOD: Foot screening tests with Semmes-Weinstein monofilament was performed in 90 diabetic inpatients to determined the risk category for diabetic foot ulcer. An average age of patients was 55 years, and an average duration of the disease was 11 years. The correlation of risk category was evaluated with age, duration of the disease, FBS (fasting blood glucose) level, HbA1c value, and complications of diabetes including retinopathy, peripheral polyneuropathy, and renal failure. RESULTS: Patients with risk category 0 had no loss of protective sensation in 34.4% of cases. Patients with risk category 1, 2, and 3 had loss of protective sensation in 16.7%, 28.9% and 20% of cases, respectively. The older a patient was and the longer the duration of the disease was, the higher the risk category was significantly (p<0.05). There was no significant correlation of risk category with FBS level and HbA1c value. Among the complications associated with diabetes, retinopathy and peripheral polyneuropathy significantly correlated with risk category (p<0.05), but renal failure was not significantly associated. CONCLUSION: The foot screening test with Semmes-Weinstein monofilament should be helpful for proper management of diabetic foot in inpatient.

The Value of the Medial Plantar Sensory Nerve Conduction Study in Diabetic Patient

OBJECTIVE: The purposes of this study were to obtain the reference values of latency and amplitude of the medial plantar sensory nerve action potential(SNAP) in normal controls and to evaluate the diagnostic sensitivity of medial plantar sensory nerve conduction study(NCS) in diabetic neuropathy. METHOD: Thirty healthy controls(mean age, 48.7 years; range, 38~59 years) and 33 diabetic patients(mean age, 50.8 years; range, 37~64 years) were included in this study. The inclusion criteria for diabetic patients were subjects with the normal peroneal and tibial compound muscle action potentials, obtainable sural SNAPs and intact pressure-perception to Semmes-Weinstein monofilament 5.07. RESULTS: The medial plantar sensory nerve action potentials were obtainable in all control subjects and the reference values of onset latency and peak to peak amplitude were 4.29+/-0.49 msec and 3.1+/-1.34 V, respectively. All 33 diabetic patients showed the normal latency and 3 of them showed the low amplitude in sural SNAPs. The medial plantar SNAPs were obtainable in 24 diabetic patients. Among 9 patients with unobtainable medial plantar SNAPs, 6 showed the normal sural SNAPs and 3 showed the low sural SNAPs. The sensitivities of medial plantar SNAPs to sural nerve and sural SNAPs to medial plantar sensory nerve were 100%(3/3) and 27.3%(3/11) respectively. CONCLUSION: We concluded that medial plantar sensory NCS was more valuable in the early diagnosis of diabetic neuropathy than the sural NCS and Semmes-Weinstein monofilament (North Coast Medical Inc, USA).