A Practical Two-Step Quantitative Clinical and Electrophysiological Assessment for the Diagnosis and Staging of Diabetic Neuropathy

Feldman, Eva L.; Stevens, Martin J.; Thomas, P. K.; Brown, Morton B.; Canal, N.; Greene, Douglas A.

doi:10.2337/diacare.17.11.1281

Cited by 1,087 publications

(941 citation statements)

References 16 publications

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“…The neuropathy definition was based on standardized examination and questionnaires, but not on a neurologist's history and examination or confirmatory measures (nerve conduction studies or skin biopsies). On the other hand, the MNSI questionnaire and examination are validated measures of neuropathy and have been used successfully in both type 1 and type 2 diabetic cohorts 28, 38, 39, 40. While the MNSI instruments have not been validated in Asian populations, the prevalence of neuropathy was comparable to a previous large Chinese cohort study using a different neuropathy definition 24.…”

Section: Discussionmentioning

confidence: 84%

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Diabetes and obesity are the main metabolic drivers of peripheral neuropathy

Callaghan

Gao

Li³

et al. 2018

Ann Clin Transl Neurol

159

110

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ObjectiveTo determine the associations between individual metabolic syndrome (MetS) components and peripheral neuropathy in a large population‐based cohort from Pinggu, China.MethodsA cross‐sectional, randomly selected, population‐based survey of participants from Pinggu, China was performed. Metabolic phenotyping and neuropathy outcomes were performed by trained personnel. Glycemic status was defined according to the American Diabetes Association criteria, and the MetS using modified consensus criteria (body mass index instead of waist circumference). The primary peripheral neuropathy outcome was the Michigan Neuropathy Screening Instrument (MNSI) examination. Secondary outcomes were the MNSI questionnaire and monofilament testing. Multivariable models were used to assess for associations between individual MetS components and peripheral neuropathy. Tree‐based methods were used to construct a classifier for peripheral neuropathy using demographics and MetS components.ResultsThe mean (SD) age of the 4002 participants was 51.6 (11.8) and 51.0% were male; 37.2% of the population had normoglycemia, 44.0% prediabetes, and 18.9% diabetes. The prevalence of peripheral neuropathy increased with worsening glycemic status (3.25% in normoglycemia, 6.29% in prediabetes, and 15.12% in diabetes, P < 0.0001). Diabetes (odds ratio [OR] 2.60, 95% CI 1.77–3.80) and weight (OR 1.09, 95% CI 1.02–1.18) were significantly associated with peripheral neuropathy. Age, diabetes, and weight were the primary splitters in the classification tree for peripheral neuropathy.InterpretationSimilar to previous studies, diabetes and obesity are the main metabolic drivers of peripheral neuropathy. The consistency of these results reinforces the urgent need for effective interventions that target these metabolic factors to prevent and/or treat peripheral neuropathy.

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Section: Discussionmentioning

confidence: 84%

“…The Michigan Neuropathy Screening Instrument (MNSI) examination and questionnaire were performed by trained personnel as previously described 28. Monofilament testing was performed with a Semmes Weinstein 5.07/10‐g monofilament on the dorsum of the dominant great toe.…”

Section: Methodsmentioning

confidence: 99%

Diabetes and obesity are the main metabolic drivers of peripheral neuropathy

Callaghan

Gao

Li³

et al. 2018

Ann Clin Transl Neurol

159

110

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“…Complications were identified using standard definitions. Peripheral sensory neuropathy was defined as a score of >2/8 on the clinical portion of the Michigan Neuropathy Screening Instrument [24]. A subject was defined as having retinopathy if any grade of retinopathy, including maculopathy, was detected by direct and/or indirect ophthalmoscopy in one or both eyes and/or more detailed assessment by an ophthalmologist.…”

Section: Clinical and Laboratory Methodsmentioning

confidence: 99%

Vascular depression in older people with diabetes

et al. 2006

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Aims/hypothesis Cerebrovascular disease may be causal or a vulnerability factor in late-onset depression and may explain the high rate of depression in older adults with diabetes. We explored a wide range of potential explanatory variables of depression in a longitudinal study of older diabetic subjects to investigate the vascular depression hypothesis in these patients. Methods We recruited 207 subjects with diabetes selected for potential cognitive deficits from an existing observational cohort study (average age 75.7±4.6 years, 52.2% men) for an assessment of depression using a standardised diagnostic instrument (Cambridge Examination for Mental Disorders of the Elderly -Revised). All subjects underwent a detailed clinical assessment at baseline and at follow-up (after 7.5± 1.1 years). Results Major depression was present in 45 subjects (21.7%) and minor depression in ten (4.8%). A positive history of strokes and the presence of peripheral arterial disease were significantly associated with depression at the time of diagnosis. In a subsample of 93 cases who underwent structural neuroimaging, the presence of cerebral infarcts was also significantly associated with depression. Treatment with glucose-lowering therapy, higher serum cholesterol levels and difficulties with activities of daily living at baseline were significant predictors of depression at follow-up. Conclusions/interpretation A history of cerebrovascular disease was strongly associated with depression and cerebrovascular risk factors were significant predictors of depression in older diabetic patients. Our findings are consistent with the hypothesis that the excess risk of depression in older diabetic patients is related to underlying cerebrovascular disease.

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“…Complications were identified using standard definitions. Peripheral sensory neuropathy was defined as a score of >2/8 on the clinical portion of the Michigan Neuropathy Screening Instrument [19]. A subject was considered to have retinopathy if any grade of retinopathy, including maculopathy, was detected by direct and/or indirect ophthalmoscopy in one or both eyes and/or on more detailed assessment by an ophthalmologist.…”

Section: Clinical Assessmentmentioning

confidence: 99%