Is it possible to substitute the monofilament test for the Ipswich Touch Test in screening for peripheral diabetic neuropathy?

Abstract

Background: This study aimed to assess the agreement and efficacy of the Ipswich Touch Test compared to the monofilament test in individuals with type 2 diabetes. Materials and methods: A cross-sectional and analytical study was conducted. The inclusion criteria were patients with type II diabetes (n = 250) who did not present ulcers or amputation in either foot. The exclusion criteria were as follows: patients who presented sequelae of cerebrovascular disease or other neurological pathologies, as well as diagnoses of malignancy, alcohol abuse, liver cirrhosis, hepatitis B, AIDS, hypothyroidism, chronic kidney disease or lupus erythaematosus, as these clinical conditions could influence or bias the results (Won and Park in Endocrinol Metab 31:230-238, 2016). Sensitivity, specificity, predictive values, likelihood ratios, and Kappa index were calculated. Other factors assessed were glycated haemoglobin and body mass index. Results: Most of the participants were female (71.2%), and glycated haemoglobin (HbA1c) was greater than 7% in 54.4% of the patients. The mean age was 59.43 years, and the mean time since diagnosis was 12.38 years. The Kappa index was 0.819 (p < 0.001), and the Ipswich Touch Test had a sensitivity of 83.33%, a specificity of 97.66%, a positive predictive value of 85.71%, a negative predictive value of 97.21%, a positive likelihood ratio of 30.19%, and a negative likelihood ratio of 0.17%. The level of significance was 5% in this study. Conclusion: The Ipswich Touch Test resented good agreement and efficacy compared to the gold standard-the 10 g monofilament test.

A review of the current evidence on the sensitivity and specificity of the Ipswich touch test for the screening of loss of protective sensation in patients with diabetes mellitus

“…1. A total of five crosssectional studies were included in this review and a summary of their characteristics are in Table 1 [8,9,[14][15][16].…”

“…While two studies did specify the ratio of Type 1 DM to Type 2 DM in their sample population, two studies did not. Only one study included only patients with Type 2 DM [16]. The inclusion and exclusion criteria differed across the studies.…”

“…Madanat et al recruited participants who were referred from primary care centres to a diabetes centre [15]. Dutra et al recruited participants from a diabetes outpatient centre who did not have present diabetic foot ulcers or amputations [16]. Only two studies clearly excluded patients with secondary causes of neuropathy [15,16].…”

“…Three studies investigated the sensitivity and specificity of the IpTT by comparing it to the 10 g MF as their reference standard [9,15,16]. The results are summarised in Table 2.…”

“…Only the studies by Madanat et al and Dutra et al had a low risk of selection bias, while it was unclear for the other studies [15,16]. These were the only two studies that specifically excluded patients who had neuropathy secondary to comorbidities, to not influence nor bias the results.…”