Diabetic neuropathy examination: a hierarchical scoring system to diagnose distal polyneuropathy in diabetes.

Meijer, J. W. G.; Sonderen, van Eric; Blaauwwiekel, EE; Smit, Andries J.; Groothoff, Johan W.; Eisma, W.H.; Links, Thera P.

doi:10.2337/diacare.23.6.750

Cited by 106 publications

(85 citation statements)

References 19 publications

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“…Physical examination scoring: DNE score. The DNE score is a sensitive and validated hierarchical scoring system (6,14). The score contains two items concerning muscle strength, one concerning reflexes, and five concerning sensation, for a total of eight items.…”

Section: Clinical Standardsmentioning

confidence: 99%

Back to Basics in Diagnosing Diabetic Polyneuropathy With the Tuning Fork!

Meijer

Smit²,

Lefrandt³

et al. 2005

Diabetes Care

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OBJECTIVE—Several national and international scoring systems are used to diagnose diabetic polyneuropathy (PNP). The variety in these scores and the lack of data on validity and predictive value has led to a comparison and validation of the scores with clinical standards for PNP to determine the most powerful measurement for screening. RESEARCH DESIGN AND METHODS—Three matched groups were selected: 24 diabetic patients with neuropathic foot ulcers, 24 diabetic patients without PNP or ulcers, and 21 control subjects without diabetes. In all participants the scores from the International Consensus on the Diabetic Foot (ICDF) and the Dutch Nederlandse Diabetes Federatie-Centraal Beleids Orgaan (NDF/CBO) were tested. The Diabetic Neuropathy Symptom score, the Diabetic Neuropathy Examination score, Heart Rate Variability, the Nerve Conduction Sum score, and a San Antonio Consensus sum score were obtained as clinical standards. Reproducibility was tested in a separate study (13 patients). RESULTS—The construct validity and discriminative power of the ICDF and NDF/CBO scores were comparable, although monofilaments (NDF/CBO) scored lower. The predictive value was good for all scores, with the best results being obtained for the tuning fork (NDF/CBO). Reproducibility of the NDF/CBO scores (monofilaments and tuning fork) was high. CONCLUSIONS—The characteristics of the scores of tests recommended by ICDF and NDF/CBO are comparable. The single use of the 128-Hz tuning fork produces results similar to the extended scores of the ICDF and much better than those of monofilaments on validation and for predictive value. For screening we therefore advise the use of the tuning fork alone.

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Section: Clinical Standardsmentioning

confidence: 99%

Back to Basics in Diagnosing Diabetic Polyneuropathy With the Tuning Fork!

Meijer

Smit²,

Lefrandt³

et al. 2005

Diabetes Care

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“…Clinical neuropathy signs were scored by means of the Diabetic Neuropathy Examination (DNE) score [23] that has a maximum score of 16 and is a modification of Neuropathy Disability Score [24]. Quantitative sensory testing was carried out with Semmes-Weinstein monofilaments.…”

Section: Assessment Of Neuropathymentioning

confidence: 99%

Sympathetic mediated vasomotion and skin capillary permeability in diabetic patients with peripheral neuropathy

et al. 2003

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Aims/hypothesis. A loss of sympathetic function could lead to changes in capillary fluid filtration in diabetic patients. We investigated whether a decreased sympathetically mediated vasomotion in the skin in diabetic patients with peripheral neuropathy is associated with an abnormal capillary leakage. Methods. Three matched groups were studied: 18 diabetic patients with documented peripheral neuropathy (DN), 18 diabetic patients without peripheral neuropathy (D), and 18 healthy control subjects (C). Sensory and motor nerve function of the distal extremities were assessed by standard neurography, and expressed in a sensory-motor nerve function score. Sympathetic vasomotion of the skin microcirculation was assessed by determining the power of blood flow variability in the low-frequency (0.02-0.14 Hz) band by spectral analysis of laser Doppler flowmetry at the median ankle. Skin capillary leakage was evaluated by sodium fluorescein videodensitometry at the same site of the foot.Results. Sympathetically mediated vasomotion of the foot skin microcirculation was lower in diabetic patients with documented peripheral neuropathy compared with diabetic patients without peripheral neuropathy and control subjects (p<0.001). Capillary sodium fluorescein leakage was larger in 18 diabetic patients with documented peripheral neuropathy than in diabetic patients without peripheral neuropathy (p<0.02) and C (p<0.005). Multiple regression analysis disclosed that a reduced sympathetically mediated vasomotion, together with a lower sensory-motor nerve function score, independently contributed to the variance in sodium fluorescein leakage, for 30% (p<0.001) and 17% (p<0.01), respectively. Conclusions. A loss of sympathetic tone, apart from sensory-motor nerve dysfunction, seems to be a major determinant of an increased capillary permeability in diabetic patients with neuropathy. [Diabetologia (2003) 46:40-47]

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“…It cannot be excluded with certainty that the application of tests other than the NSS and NDS used in the current study could have led to different ratings. However, currently no gold standard exists for diagnosing diabetic polyneuropathy [48] and the tests applied in this study meet the required criteria as outlined previously [47,48].…”

Section: Discussionmentioning

confidence: 99%

Diabetic polyneuropathy is associated with respiratory muscle impairment in type 2 diabetes

et al. 2007

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Aims/hypothesis Diabetes has a major negative effect on intensive care unit outcome. This has been partly attributed to impaired respiratory neuromuscular function. However, data on respiratory neuromuscular involvement in diabetes are lacking. This study therefore aimed to assess respiratory neuromuscular function related to diabetic polyneuropathy in patients with type 2 diabetes. Methods Respiratory neuromuscular function was assessed by the use of volitional tests and twitch mouth (TwPmo) and twitch transdiaphragmatic (TwPdi) pressures during non-volitional bilateral anterior magnetic phrenic nerve stimulation in 21 male type 2 diabetic patients without pulmonary disease and in 23 healthy, well-matched controls (forced expiratory volume in 1 s 103±11 vs 103±12% predicted; p=0.9). Results Both volitionally assessed maximal inspiratory and expiratory mouth pressures, and sniff nasal and transdiaphragmatic pressures were comparable between diabetic patients and controls (p>0

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Diabetic neuropathy examination: a hierarchical scoring system to diagnose distal polyneuropathy in diabetes.

Cited by 106 publications

References 19 publications

Back to Basics in Diagnosing Diabetic Polyneuropathy With the Tuning Fork!

Back to Basics in Diagnosing Diabetic Polyneuropathy With the Tuning Fork!

Sympathetic mediated vasomotion and skin capillary permeability in diabetic patients with peripheral neuropathy

Diabetic polyneuropathy is associated with respiratory muscle impairment in type 2 diabetes

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