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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.

PURPOSE:
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.
METHODS:
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).
RESULTS:
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.
CONCLUSION:
PSSD has a greater accuracy in detecting early stage DPP compared to CASE-IV. Both devices offer high sensitivity over traditional qualitative testing.


Back to 2016 Joint Meeting Posters