A simplified protocol to screen for distal polyneuropathy in type 2 diabetic patients

Costa, Luciana A.; Maraschin, Jorge F.; Xavier de Castro, José H.; Gross, Jorge L.; Friedman, Rogério

doi:10.1016/j.diabres.2006.02.005

« Previous Next »Diabetes Research and Clinical Practice
Volume 73, Issue 3 , Pages 292-297, September 2006

A simplified protocol to screen for distal polyneuropathy in type 2 diabetic patients

Luciana A. Costa
- Endocrine Division, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
Jorge F. Maraschin
- Endocrine Division, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
José H. Xavier de Castro
- Neurology Division, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
Jorge L. Gross
- Endocrine Division, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
Rogério Friedman
- Endocrine Division, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
- Corresponding author at: Serviço de Endocrinologia, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos 2350, Prédio 12-4° andar, 90035-903 Porto Alegre, RS, Brazil. Tel.: +55 51 3332 5188; fax: +55 51 2101 8777.

Received 18 April 2005; received in revised form 21 January 2006; accepted 7 February 2006. published online 27 March 2006.

Abstract

To test a simplified protocol to screen type 2 diabetic patients (DM2) for distal polyneuropathy (DPN), 80 outpatients and 45 controls answered a symptom questionnaire, underwent a directed examination (pin-prick, tuning fork, monofilament, ankle jerk, cold spatula and walking on heels), autonomic tests, and an electroneurophysiological study (EMG). Symptoms were also analysed as scores. DPN was diagnosed in the presence of abnormal EMG (or autonomic neuropathy), plus one symptom or one abnormal objective finding. Symptoms were equally frequent in patients (56%) and controls (35%, P=0.20). Objective findings were more frequent in patients (62/80 versus 11/45; P<0.05). The 60 DM2 patients with DPN were older, with longer diabetes duration and more often hypertensive than those without DPN. The 15 patients unable to walk on heels had DPN (sensitivity 20.8%, specificity 100%, positive predictive value 100% and negative predictive value 12.3%). The 12 patients able to walk on heels but with three or more abnormal tests had DPN (sensitivity 21.1%, specificity 100%, positive predictive value 100% and negative predictive value 15.1%). Isolated signs and symptoms do not identify patients with DPN. Patients with higher degrees of impairment can be identified by six simple ambulatory tests, reducing in one-third the need for EMG.