Skip Navigation
Skip to contents

Diabetes Metab J : Diabetes & Metabolism Journal

Search
OPEN ACCESS

Articles

Page Path
HOME > Diabetes Metab J > Volume 42(5); 2018 > Article
Brief Report
Complications The Necessity of the Simple Tests for Diabetic Peripheral Neuropathy in Type 2 Diabetes Mellitus Patients without Neuropathic Symptoms in Clinical Practice
Jung Hwan Park, Dong Sun Kimorcid
Diabetes & Metabolism Journal 2018;42(5):442-446.
DOI: https://doi.org/10.4093/dmj.2017.0090
Published online: October 22, 2018
  • 4,953 Views
  • 75 Download
  • 18 Web of Science
  • 16 Crossref
  • 14 Scopus

Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea.

corresp_icon Corresponding author: Dong Sun Kim. Department of Internal Medicine, Hanyang University College of Medicine, 222-1 Wangsimni-ro, Seongdong-gu, Seoul 04763, Korea. dongsun@hanyang.ac.kr
• Received: December 7, 2017   • Accepted: August 22, 2018

Copyright © 2018 Korean Diabetes Association

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

prev next
  • Early recognition and appropriate management of diabetic peripheral polyneuropathy (DPNP) is important. We evaluated the necessity of simple, non-invasive tests for DPNP detection in clinical practice. We enrolled 136 randomly-chosen patients with type 2 diabetes mellitus and examined them with the 10-g Semmes-Weinstein monofilament examination, the 128-Hz tuning-fork, ankle-reflex, and pinprick tests; the Total Symptom Score and the 15-item self-administered questionnaire of the Michigan Neuropathy Screening Instrument. Among 136 patients, 48 had subjective neuropathic symptoms and 88 did not. The abnormal-response rates varied depending on the methods used according to the presence of subjective neuropathic symptoms (18.8% vs. 5.7%, P<0.05; 58.3% vs. 28.4%, P<0.005; 81.3% vs. 54.5%, P<0.005; 12.5% vs. 5.7%, P=0.195; 41.7% vs. 2.3%, P<0.001; and 77.1% vs. 9.1%, P<0.001; respectively). The largest abnormal response was derived by combining all methods. Moreover, these tests should be implemented more extensively in diabetic patients without neuropathic symptoms to detect DPNP early.
Diabetic peripheral polyneuropathy (DPNP) is the most common microvascular complication and an amputation risk factor in patients with diabetes [12]. Therefore, early recognition and appropriate management of DPNP are important.
Unfortunately, methods for DPNP detection are underutilized in primary-care practice and DPNP is underdiagnosed [34]. To confirm the diagnosis, a nerve-conduction study or skin biopsy is required [56]. However, these procedures are invasive and may be unsuitable for use in clinical practice [7]. The identification of potential patients with DPNP, particularly by non-specialists, requires easily applicable and clinically reliable screening and diagnostic methods. Various diagnostic methods have so far been developed and used [89]. In this study, we evaluated the diagnostic correlation of simple and non-invasive methods appropriate for DPNP detection in patients with type 2 diabetes mellitus (T2DM) according to the presence of neuropathic symptoms to reconfirm the necessity of these tests in clinical practice.
Study population
We enrolled 162 patients with T2DM who were randomly chosen. The subjects were examined with all screening tests including the 10-g Semmes-Weinstein monofilament examination (SWME), the 128-Hz tuning-fork, ankle-reflex, and pinprick tests; the Total Symptom Score (TSS), and the 15-item self-administered questionnaire of the Michigan Neuropathy Screening Instrument (MNSI questionnaire) between January 2013 and December 2013 at one tertiary hospital. Examinations except for the TSS and MNSI questionnaire were performed by one examiner who did not recognize the presence of symptoms. We excluded 26 patients with chronic alcohol abuse, end stage terminal disease (chronic kidney disease, hepatic dysfunction, or cancer), vitamin deficiency (B1, B6, B12, E, or folic acid), or who were receiving neurotoxic medications [10]. Subjective neuropathic symptoms were defined as symmetrical burning pain, electrical sensation, stabbing sensation, paresthesia, or deep aching pain in the lower limbs having started at the toes. All included subjects were aged ≥40 years.
This study was approved by the Institutional Review Board of the Hanyang University Hospital in Seoul, Korea (No. HYUH 2014-05-002).
Tests for diabetic peripheral polyneuropathy
The SWME was performed at 10 touch sites (one dorsal and nine plantar sites) per foot. The monofilament was applied perpendicular to the foot and touched the skin until it bended by approximately 1 cm. The total duration of the approach, skin contact, and monofilament removal should be approximately 2 seconds. A total score ≤8/10 was considered abnormal [11].
The 128-Hz tuning-fork test was bilaterally applied to the bony prominence situated at the dorsum of the first toe proximal to the nail bed. The patient was asked to report the time when vibration diminished below perception. The tuning-fork was also applied to the dorsal aspect of the distal phalanx of the examiner's thumb [12]. A detection-time difference between the patient and the examiner ≥10 seconds was considered abnormal.
The ankle-reflex test was performed at both ankles. While the patient was kneeling, the examiner dorsiflexed the foot and gently stroked the Achilles tendon with the reflex hammer [11]. An absent or decreased ankle reflex was considered abnormal.
The pinprick test was performed over the plantar aspect of the distal first, third, and fifth toes of each foot with the stimulus applied once per site [11]. An absent or dull sensation was considered abnormal.
The MNSI questionnaire was self-administered. ‘Yes’ responses to questions 1–3, 5–6, 8–9, 11–12, 14–15 and ‘No’ responses to questions 7 and 13 were each counted as one point. Questions 4 and 10 are not included in the published scoring algorithm [13]. A total score ≥3 was considered abnormal.
The TSS was self-administered. The patient was asked to assess the intensity (absent, mild, moderate, or severe) and the frequency (occasional, frequent, or continuous) of four symptoms (pain, burning, paresthesia, and numbness) [14]. A total score ≥4 was considered abnormal.
Statistical analyses
Data analyses were performed using SPSS version 18.0 for Windows (SPSS Inc., Chicago, IL, USA). An independent t-test was used for continuous data and the chi-square and Fisher's exact tests for categorical data. A P<0.05 was considered statistically significant.
The baseline characteristics of the 136 patients are described in Table 1. Forty-eight patients (35.3%) had subjective neuropathic symptoms. There was a significant difference in sex but not in age, duration of T2DM, glycosylated hemoglobin, prevalence of hypertension, dyslipidemia, diabetic macrovascular complications, glomerular filtration rate, and mode of treatment between the patients with and without subjective neuropathic symptoms.
The results of all six methods for the detection of DPNP are described in Table 2. The abnormal response rates varied depending on the methods used. The abnormal responses in the pinprick, 128-Hz tuning-fork, and ankle-reflex tests in patients with subjective neuropathic symptoms were similar to those in patients without neuropathic symptoms (6 [54.5%] vs. 5 [45.5%]; 28 [52.8%] vs. 25 [47.2%]; 39 [44.8%] vs. 48 [55.2%]). However, the abnormal responses in the SWME in patients with subjective neuropathic symptoms were larger than those in patients without neuropathic symptoms (9 [64.3%] vs. 5 [35.7%]). The result derived from a combination of the pinprick, SWME, 128-Hz tuning-fork, and ankle-reflex tests was the same as that derived from a combination of the 128-Hz tuning-fork and ankle-reflex tests. Abnormal responses in the MNSI questionnaire and TSS in patients with subjective neuropathic symptoms were larger than in patients without neuropathic symptoms. The result derived from the combination of the MNSI questionnaire and TSS was similar to that of the MNSI questionnaire. The largest abnormal response was derived from the combination of all methods.
This study showed that a combination of simple and non-invasive methods would be better than using just one test for detecting DPNP in clinical practice in diabetic groups irrespective of subjective neuropathic symptoms. The MNSI questionnaire could be useful for the detection of DPNP in patients with subjective neuropathic symptoms.
Instruments such as the SWME, ankle-reflex, and 128-Hz tuning-fork tests have been recommended as screening tools for DPNP [9]. They can be used alone or combined to assess and contribute to the clinical diagnosis of DPNP. It was reported that the combination of these tests had greater than 87% sensitivity for DPNP detection [15]. In this study, we found that combining at least the 128-Hz tuning-fork and ankle-reflex tests would be needed for the detection of DPNP.
We observed that the MNSI questionnaire could be a useful tool for detecting DPNP in patients with neuropathic symptoms. The MNSI includes a 15-item self-administered questionnaire and a lower-extremity examination [13]. When used separately, the MNSI questionnaire and the examination performed similarly in predicting confirmed clinical neuropathy [16]. However, among patients with DPNP, up to 50% may be asymptomatic [9]. Therefore, a combination of various tests would be required for the detection of DPNP in patients with T2DM.
This study has several limitations. First, all tests except for the TSS and MNSI questionnaire were performed by one examiner who did not recognize whether the subjects had neuropathic symptoms. However, the results would vary depending on the level of the examiner's proficiency. Second, the diagnosis of DPNP would have been more certain if we had performed nerve-conduction studies and skin biopsies.
In conclusion, our findings indicate that in diabetic patients with and without neuropathic symptoms, examination with as many tests and questionnaires as possible is important for early DPNP detection.

CONFLICTS OF INTEREST: No potential conflict of interest relevant to this article was reported.

  • 1. Chaturvedi N, Stevens LK, Fuller JH, Lee ET, Lu M. Risk factors, ethnic differences and mortality associated with lower-extremity gangrene and amputation in diabetes. The WHO Multinational Study of Vascular Disease in Diabetes. Diabetologia 2001;44(Suppl 2):S65-S71. ArticlePubMedPDF
  • 2. Carlson T, Reed JF 3rd. A case-control study of the risk factors for toe amputation in a diabetic population. Int J Low Extrem Wounds 2003;2:19-21. ArticlePubMedPDF
  • 3. Herman WH, Kennedy L. Underdiagnosis of peripheral neuropathy in type 2 diabetes. Diabetes Care 2005;28:1480-1481. ArticlePubMedPDF
  • 4. Kirkman MS, Williams SR, Caffrey HH, Marrero DG. Impact of a program to improve adherence to diabetes guidelines by primary care physicians. Diabetes Care 2002;25:1946-1951. ArticlePubMedPDF
  • 5. Juster-Switlyk K, Smith AG. Updates in diabetic peripheral neuropathy. F1000Res 2016;5(F1000 Faculty Rev):738.ArticlePDF
  • 6. Bril V, Tomioka S, Buchanan RA, Perkins BA. mTCNS Study Group. Reliability and validity of the modified Toronto Clinical Neuropathy Score in diabetic sensorimotor polyneuropathy. Diabet Med 2009;26:240-246. ArticlePubMedPMC
  • 7. Deli G, Bosnyak E, Pusch G, Komoly S, Feher G. Diabetic neuropathies: diagnosis and management. Neuroendocrinology 2013;98:267-280. ArticlePubMedPDF
  • 8. Ko SH, Cha BY. Diabetic peripheral neuropathy in type 2 diabetes mellitus in Korea. Diabetes Metab J 2012;36:6-12. ArticlePubMedPMC
  • 9. Pop-Busui R, Boulton AJ, Feldman EL, Bril V, Freeman R, Malik RA, Sosenko JM, Ziegler D. Diabetic neuropathy: a position statement by the American Diabetes Association. Diabetes Care 2017;40:136-154. ArticlePubMedPDF
  • 10. Ziegler D, Keller J, Maier C, Pannek J. German Diabetes Association. Diabetic neuropathy. Exp Clin Endocrinol Diabetes 2014;122:406-415. ArticlePubMed
  • 11. Smieja M, Hunt DL, Edelman D, Etchells E, Cornuz J, Simel DL. Clinical examination for the detection of protective sensation in the feet of diabetic patients. International Cooperative Group for Clinical Examination Research. J Gen Intern Med 1999;14:418-424. ArticlePubMedPMC
  • 12. Perkins BA, Olaleye D, Zinman B, Bril V. Simple screening tests for peripheral neuropathy in the diabetes clinic. Diabetes Care 2001;24:250-256. ArticlePubMedPDF
  • 13. Feldman EL, Stevens MJ, Thomas PK, Brown MB, Canal N, Greene DA. A practical two-step quantitative clinical and electrophysiological assessment for the diagnosis and staging of diabetic neuropathy. Diabetes Care 1994;17:1281-1289. ArticlePubMedPDF
  • 14. Mijnhout GS, Kollen BJ, Alkhalaf A, Kleefstra N, Bilo HJ. Alpha lipoic acid for symptomatic peripheral neuropathy in patients with diabetes: a meta-analysis of randomized controlled trials. Int J Endocrinol 2012;2012:456279. ArticlePubMedPMCPDF
  • 15. Vinik A, Ullal J, Parson HK, Casellini CM. Diabetic neuropathies: clinical manifestations and current treatment options. Nat Clin Pract Endocrinol Metab 2006;2:269-281. ArticlePubMedPDF
  • 16. Herman WH, Pop-Busui R, Braffett BH, Martin CL, Cleary PA, Albers JW, Feldman EL. DCCT/EDIC Research Group. Use of the Michigan Neuropathy Screening Instrument as a measure of distal symmetrical peripheral neuropathy in type 1 diabetes: results from the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications. Diabet Med 2012;29:937-944. ArticlePubMedPMCPDF
Table 1

Baseline characteristics of the patients enrolled in the study and according to the presence of subjective neuropathic symptoms

dmj-42-442-i001.jpg
Characteristic Total (n=136) Symptoma (n=48) No symptomb (n=88) P value
Male sex 68 (50.0) 18 (37.5) 50 (56.8) 0.048
Age, yr 59.4±12.2 59.9±11.6 59.2±12.5 0.751
Duration of T2DM, yr 10.5±9.3 11.6±9.9 9.9±8.9 0.306
HbA1c, % 8.0±2.0 8.1±1.7 7.9±2.1 0.639
eGFRc, mL/min/1.73 m2 90.09±11.87 89.38±11.81 90.49±11.95 0.605
Hypertensiond 85 (62.5) 33 (68.8) 52 (59.1) 0.177
Dyslipidemiae 51 (37.5) 21 (43.8) 30 (34.1) 0.177
Vascular diseasef 20 (14.7) 9 (18.8) 11 (12.5) 0.230
Mode of treatment 0.252
 OADg 113 (83.1) 38 (79.2) 75 (85.2)
 OAD+insulinh 23 (16.9) 10 (20.8) 13 (14.8)

Values are presented as number (%) or mean±standard deviation.

T2DM, type 2 diabetes mellitus; HbA1c, glycosylated hemoglobin; eGFR, estimated glomerular filtration rate; OAD, oral anti-diabetic drug.

aPatients had subjective neuropathic symptoms, bPatients had no subjective neuropathic symptoms, ceGFR is estimated GFR calculated by the Modification of Diet in Renal Disease equation, dHypertension was defined if any of the following criteria were met; use of antihypertensive medication, systolic blood pressure ≥140 mm Hg, or diastolic blood pressure ≥90 mm Hg, eDyslipidemia was defined if any of the following criteria were met; use of a lipid-lowering medication or plasma total cholesterol ≥240 mg/dL, fVascular disease was defined if any of the following criteria were met; cardiovascular disease, stroke and cerebrovascular disease or peripheral artery disease, gPatients were treated with one or more OADs, hPatients were treated with a combination of one or more OADs and insulin.

Table 2

Results of all methods according to the presence of subjective neuropathic symptoms

dmj-42-442-i002.jpg
Methods Patients with symptomsa Patients with no symptomb
Abnormal Normal Abnormal Normal
Tests
 Pinprick test 6 (12.5) 42 (87.5) 5 (5.7) 83 (94.3)
 SWMEd 9 (18.8) 39 (81.2) 5 (5.7) 83 (94.3)
 Tuning-forkc,e 28 (58.3) 20 (41.7) 25 (28.4) 63 (71.6)
 Ankle reflexe 39 (81.3) 9 (18.7) 48 (54.5) 40 (45.5)
 Any of above 4d 42 (87.5) 6 (12.5) 59 (67.0) 29 (33.0)
 Pinprick test+Tuning-forkf 29 (60.4) 19 (39.6) 25 (28.4) 63 (71.6)
 Pinprick test+Ankle reflexe 39 (81.3) 9 (18.7) 50 (56.8) 38 (43.2)
 SWME+Tuning-forke 29 (60.4) 19 (39.6) 25 (28.4) 63 (71.6)
 SWME+Ankle reflexe 39 (81.3) 9 (18.7) 49 (55.7) 39 (44.3)
 Tuning-fork+Ankle reflexd 42 (87.5) 6 (12.5) 59 (67.0) 29 (33.0)
Questionnaires
 MNSI questionnairef 37 (77.1) 11 (22.9) 8 (9.1) 80 (90.9)
 Total Symptom Scoref 20 (41.7) 28 (58.3) 2 (2.3) 86 (97.7)
 Any of above 2f 37 (77.1) 11 (22.9) 9 (10.2) 79 (89.8)
All 6 abovef 47 (97.9) 1 (2.1) 62 (70.5) 26 (29.5)

Values are presented as number (%).

SWME, 10-g Semmes-Weinstein monofilament examination; MNSI questionnaire, 15-item self-administered questionnaire in the Michigan Neuropathy Screening Instrument.

aPatients had subjective neuropathic symptoms, bPatients had no subjective neuropathic symptoms, c128-Hz tuning-fork, statistical significance is marked as dP<0.05, eP<0.01, fP<0.001.

Figure & Data

References

    Citations

    Citations to this article as recorded by  
    • Risk factors associated with the severity of overactive bladder among Syrian patients with type 2 diabetes
      Fater A. Khadour, Younes A. Khadour, Weaam Alhatem, Deema Al Barroush
      Scientific Reports.2024;[Epub]     CrossRef
    • Risk factors associated with overactive bladder severity in patients with type 2 diabetes
      Fater A. Khadour, Younes A. Khadour, Weaam Alhatem, Deema Al Barroush, Tao Xu
      Neurourology and Urodynamics.2024; 43(8): 1835.     CrossRef
    • A Machine Learning-Based Severity Prediction Tool for the Michigan Neuropathy Screening Instrument
      Fahmida Haque, Mamun B. I. Reaz, Muhammad E. H. Chowdhury, Mohd Ibrahim bin Shapiai, Rayaz A. Malik, Mohammed Alhatou, Syoji Kobashi, Iffat Ara, Sawal H. M. Ali, Ahmad A. A. Bakar, Mohammad Arif Sobhan Bhuiyan
      Diagnostics.2023; 13(2): 264.     CrossRef
    • Effect of Diabetic Neuropathy on Reparative Ability and Immune Response System
      Emina Karahmet Sher, Besim Prnjavorac, Esma Karahmet Farhat, Benjamin Palić, Sabah Ansar, Farooq Sher
      Molecular Biotechnology.2023;[Epub]     CrossRef
    • Novel therapeutical approaches based on neurobiological and genetic strategies for diabetic polyneuropathy – A review
      Emina Karahmet Sher, Amina Džidić-Krivić, Alma Karahmet, Merima Beća-Zećo, Esma Karahmet Farhat, Adaleta Softić, Farooq Sher
      Diabetes & Metabolic Syndrome: Clinical Research & Reviews.2023; 17(11): 102901.     CrossRef
    • SUDOSCAN in Combination with the Michigan Neuropathy Screening Instrument Is an Effective Tool for Screening Diabetic Peripheral Neuropathy
      Tae Jung Oh, Yoojung Song, Hak Chul Jang, Sung Hee Choi
      Diabetes & Metabolism Journal.2022; 46(2): 319.     CrossRef
    • Detection of diabetic polyneuropathy in a family medicine clinic by using monofilament
      Biljana Lakic, Verica Petrovic, Maja Racic, Kosana Stanetic
      Vojnosanitetski pregled.2022; 79(4): 383.     CrossRef
    • Effectiveness of Semmes Weinstein 10 gm monofilament in diabetic peripheral neuropathy taking nerve conduction and autonomic function study as reference tests
      Suchitra Dube, Sandip M. Hulke, Santosh L. Wakode, Sagar Khadanga, Avinash E. Thakare, Rajay N. Bharshankar, Abhijit Pakhare
      Journal of Family Medicine and Primary Care.2022; 11(10): 6204.     CrossRef
    • Association between Sleep Quality and Painless Diabetic Peripheral Neuropathy Assessed by Current Perception Threshold in Type 2 Diabetes Mellitus
      Dughyun Choi, Bo-Yeon Kim, Chan-Hee Jung, Chul-Hee Kim, Ji-Oh Mok
      Diabetes & Metabolism Journal.2021; 45(3): 358.     CrossRef
    • Diabetic neuropathies
      Kamakshi Patel, Holli Horak, Ezgi Tiryaki
      Muscle & Nerve.2021; 63(1): 22.     CrossRef
    • Diabetic peripheral neuropathy
      Joyce K. Anastasi, Chloe Klug
      Nursing.2021; 51(4): 34.     CrossRef
    • A nomogram-based diabetic sensorimotor polyneuropathy severity prediction using Michigan neuropathy screening instrumentations
      Fahmida Haque, Mamun Bin Ibne Reaz, Muhammad E.H. Chowdhury, Sawal Hamid Md Ali, Ahmad Ashrif A Bakar, Tawsifur Rahman, Syoji Kobashi, Chitra A. Dhawale, Mohammad Arif Sobhan Bhuiyan
      Computers in Biology and Medicine.2021; 139: 104954.     CrossRef
    • Diabetic Peripheral Neuropathy: Is it Underdiagnosed?
      Rizaldy T. Pinzon, M. Kes, Rosa De Lima R. Sa
      Asian Journal of Biological Sciences.2020; 13(2): 168.     CrossRef
    • Risk factors associated with the progression of overactive bladder among patients with type 2 diabetes
      Yiyi Zhu, Zaisheng Zhu, Jiajun Chen
      International Journal of Clinical Practice.2019;[Epub]     CrossRef
    • Response: The Necessity of the Simple Tests for Diabetic Peripheral Neuropathy in Type 2 Diabetes Mellitus Patients without Neuropathic Symptoms in Clinical Practice (Diabetes Metab J 2018;42:442–6)
      Jung Hwan Park, Dong Sun Kim
      Diabetes & Metabolism Journal.2018; 42(6): 546.     CrossRef
    • Letter: The Necessity of the Simple Tests for Diabetic Peripheral Neuropathy in Type 2 Diabetes Mellitus Patients without Neuropathic Symptoms in Clinical Practice (Diabetes Metab J 2018;42:442-6)
      Jun Hwa Hong
      Diabetes & Metabolism Journal.2018; 42(6): 544.     CrossRef

    • PubReader PubReader
    • Cite this Article
      Cite this Article
      export Copy Download
      Close
      Download Citation
      Download a citation file in RIS format that can be imported by all major citation management software, including EndNote, ProCite, RefWorks, and Reference Manager.

      Format:
      • RIS — For EndNote, ProCite, RefWorks, and most other reference management software
      • BibTeX — For JabRef, BibDesk, and other BibTeX-specific software
      Include:
      • Citation for the content below
      The Necessity of the Simple Tests for Diabetic Peripheral Neuropathy in Type 2 Diabetes Mellitus Patients without Neuropathic Symptoms in Clinical Practice
      Diabetes Metab J. 2018;42(5):442-446.   Published online October 22, 2018
      Close
    • XML DownloadXML Download
    Related articles
    The Necessity of the Simple Tests for Diabetic Peripheral Neuropathy in Type 2 Diabetes Mellitus Patients without Neuropathic Symptoms in Clinical Practice
    The Necessity of the Simple Tests for Diabetic Peripheral Neuropathy in Type 2 Diabetes Mellitus Patients without Neuropathic Symptoms in Clinical Practice
    CharacteristicTotal (n=136)Symptoma (n=48)No symptomb (n=88)P value
    Male sex68 (50.0)18 (37.5)50 (56.8)0.048
    Age, yr59.4±12.259.9±11.659.2±12.50.751
    Duration of T2DM, yr10.5±9.311.6±9.99.9±8.90.306
    HbA1c, %8.0±2.08.1±1.77.9±2.10.639
    eGFRc, mL/min/1.73 m290.09±11.8789.38±11.8190.49±11.950.605
    Hypertensiond85 (62.5)33 (68.8)52 (59.1)0.177
    Dyslipidemiae51 (37.5)21 (43.8)30 (34.1)0.177
    Vascular diseasef20 (14.7)9 (18.8)11 (12.5)0.230
    Mode of treatment0.252
     OADg113 (83.1)38 (79.2)75 (85.2)
     OAD+insulinh23 (16.9)10 (20.8)13 (14.8)
    MethodsPatients with symptomsaPatients with no symptomb
    AbnormalNormalAbnormalNormal
    Tests
     Pinprick test6 (12.5)42 (87.5)5 (5.7)83 (94.3)
     SWMEd9 (18.8)39 (81.2)5 (5.7)83 (94.3)
     Tuning-forkc,e28 (58.3)20 (41.7)25 (28.4)63 (71.6)
     Ankle reflexe39 (81.3)9 (18.7)48 (54.5)40 (45.5)
     Any of above 4d42 (87.5)6 (12.5)59 (67.0)29 (33.0)
     Pinprick test+Tuning-forkf29 (60.4)19 (39.6)25 (28.4)63 (71.6)
     Pinprick test+Ankle reflexe39 (81.3)9 (18.7)50 (56.8)38 (43.2)
     SWME+Tuning-forke29 (60.4)19 (39.6)25 (28.4)63 (71.6)
     SWME+Ankle reflexe39 (81.3)9 (18.7)49 (55.7)39 (44.3)
     Tuning-fork+Ankle reflexd42 (87.5)6 (12.5)59 (67.0)29 (33.0)
    Questionnaires
     MNSI questionnairef37 (77.1)11 (22.9)8 (9.1)80 (90.9)
     Total Symptom Scoref20 (41.7)28 (58.3)2 (2.3)86 (97.7)
     Any of above 2f37 (77.1)11 (22.9)9 (10.2)79 (89.8)
    All 6 abovef47 (97.9)1 (2.1)62 (70.5)26 (29.5)
    Table 1 Baseline characteristics of the patients enrolled in the study and according to the presence of subjective neuropathic symptoms

    Values are presented as number (%) or mean±standard deviation.

    T2DM, type 2 diabetes mellitus; HbA1c, glycosylated hemoglobin; eGFR, estimated glomerular filtration rate; OAD, oral anti-diabetic drug.

    aPatients had subjective neuropathic symptoms, bPatients had no subjective neuropathic symptoms, ceGFR is estimated GFR calculated by the Modification of Diet in Renal Disease equation, dHypertension was defined if any of the following criteria were met; use of antihypertensive medication, systolic blood pressure ≥140 mm Hg, or diastolic blood pressure ≥90 mm Hg, eDyslipidemia was defined if any of the following criteria were met; use of a lipid-lowering medication or plasma total cholesterol ≥240 mg/dL, fVascular disease was defined if any of the following criteria were met; cardiovascular disease, stroke and cerebrovascular disease or peripheral artery disease, gPatients were treated with one or more OADs, hPatients were treated with a combination of one or more OADs and insulin.

    Table 2 Results of all methods according to the presence of subjective neuropathic symptoms

    Values are presented as number (%).

    SWME, 10-g Semmes-Weinstein monofilament examination; MNSI questionnaire, 15-item self-administered questionnaire in the Michigan Neuropathy Screening Instrument.

    aPatients had subjective neuropathic symptoms, bPatients had no subjective neuropathic symptoms, c128-Hz tuning-fork, statistical significance is marked as dP<0.05, eP<0.01, fP<0.001.

    Park JH, Kim DS. The Necessity of the Simple Tests for Diabetic Peripheral Neuropathy in Type 2 Diabetes Mellitus Patients without Neuropathic Symptoms in Clinical Practice. Diabetes Metab J. 2018;42(5):442-446.
    Received: Dec 07, 2017; Accepted: Aug 22, 2018
    DOI: https://doi.org/10.4093/dmj.2017.0090.

    Diabetes Metab J : Diabetes & Metabolism Journal
    Close layer
    TOP