Comparison of Diabetic Peripheral Polyneuropathy Detection Rate in High-Sensibility Quantitative Sensory Testing Devices Against Symptom Score Scales: a Prospective Cross-Sectional Study
Alexandru Nistor, M.D., Ph.D., Sorin Barac, M.D., Ph.D., Mihai Ionac, M.D., Ph.D..
Victor Babes University of Medicine and Pharmacy, Timisoara, Romania.
Current evidence indicates early detection of diabetic peripheral polyneuropathy (DPP), followed by surgical microneurolysis of entrapped peripheral nerves, results in fewer foot ulcers and amputations. A definite diagnostic test for the early detection of DPP is lacking. We objectively compared detection rates for early stage DPP of the two available quantitative sensory testing devices against 5 established qualitative symptom scores.
94 diabetes mellitus patients were referred by diabetologists for neuropathic-like complaints. Relevant traumatic pain history, positive psychiatric evaluation, venous pathology and ABI index < 0.7 was used as exclusion criteria.
HbA1c levels were determined and recorded.
Qualitative testing was performed by administering: MD Anderson Brief Pain Inventory, Neuropathy Symptom Score, Douleur Neuropathique 4 Questionnaire, Leeds Assessment of Neuropathic Symptoms and Signs Pain Scale, Neuropathic Pain Scale and Michigan Neuropathy Screening Instrument.
Quantitative sensory testing was performed using the Computer Aided Sensory Evaluation (CASE-IV QST) Device and the Pressure-Specified Sensory Device (PSSD).
68 patients, age 47-83, were diagnosed with DPP. Mean HbA1c levels was 7.25% (range 5.27-10.1%). Mean Just Noticeable Difference (JND) was 18.98(posterior tibial nerve) and 19.09(anterior tibial nerve). Mean two-point-discrimination was 18.4mm and sensory amplitude ranged from 31.52g/mm2 (dorsal foot) to 41.7g/mm2 (great toe pulp). Sensitivity of PSSD vs CASE-IV was 98% vs 91%, specificity was 14% vs 19%. Only 1 qualitative symptom score identified DPP consistently in the study group.
PSSD has a greater accuracy in detecting early stage DPP compared to CASE-IV. Both devices offer high sensitivity over traditional qualitative testing.
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