Usefulness of Questionnaires, Physical Examination and Median Mixed Nerve Conduction Studies in Patients with Diabetes Mellitus

ABSTRACT

OBJECTIVE: To find simple screening method for assessment of patients with diabetic neuropathy by use of brief questionnaire, scored physical examination including vibration perception threshold, and mixed median conduction study. METHOD: Subjects were 24 patients with diabetes mellitus. Conventional nerve conduction study was performed in 24 patients and the patients were divided into two groups 11 patients with polyneuropathy; 13 patients of normal findings. The questionnaires were given for evaluation of sensory function in all the subjects. The questionnaires were followed by physical examination including two point discrimination, vibration perception threshold by using biothesiometer, 10 gram filament test, pin prick test, DTR check, and muscle strength test. Abnormality was determined by the number of positive responses or abnormal clinical findings. Finally, we recorded the conduction velocity and amplitude of median mixed nerve and compared these parameters to values of 20 normal adults. RESULTS: The questionnaire and physical exam scores were higher in patients with polyneuropathy (p<0.01). The patients with polyneuropathy showed higher vibration perception threshold values (p<0.01) and slower conduction velocity and smaller amplitude of median mixed nerve (p<0.05). In correlation with conventional nerve conduction study, the median mixed nerve conduction velocity had higher kappa value than amplitude in screening for diabetic polyneuropathy. CONCLUSION: We suggest the questionnaires, scored physical examination, vibration perception threshold, and median mixed nerve conduction velocity to be a simple screening method for assessment of patients with diabetic plyneuropathy.