Clinical Diagnosis of Diabetic Polyneuropathy With the Diabetic Neuropathy Symptom and Diabetic Neuropathy Examination Scores
- Jan-Willem G. Meijer, MD, PHD12,
- Eelke Bosma, MD3,
- Johan D. Lefrandt, MD3,
- Thera P. Links, MD, PHD4,
- Andries J. Smit, MD, PHD3,
- Roy E. Stewart2,
- Johannes H. van der Hoeven, MD, PHD5 and
- Klaas Hoogenberg, MD, PHD6
- 1Rehabilitation Center, Tolbrug/Jeroen Bosch Hospital, Den Bosch, the Netherlands
- 2Northern Center for Health Care Research, Groningen, the Netherlands
- 3Department of Internal Medicine, University Hospital Groningen, Groningen, the Netherlands
- 4Department of Endocrinology, University Hospital Groningen, Groningen, the Netherlands
- 5Department of Neurology, University Hospital Groningen, Groningen, the Netherlands
- 6Department of Internal Medicine, Martini Hospital, Groningen, the Netherlands
Abstract
OBJECTIVE—To evaluate the discriminative power of the Diabetic Neuropathy Symptom (DNS) and Diabetic Neuropathy Examination (DNE) scores for diagnosing diabetic polyneuropathy (PNP), as well as their relation with cardiovascular autonomic function testing (cAFT) and electro-diagnostic studies (EDS).
RESEARCH DESIGN AND METHODS—Three groups (matched for age and sex) were selected: 24 diabetic patients with neuropathic foot ulcers (DU), 24 diabetic patients without clinical neuropathy or ulcers (DC), and 21 control subjects without diabetes (C). In all participants, the DNS and DNE scores were assessed and cAFT (heart rate variability [HRV], baroreflex sensitivity [BRS]), and EDS were performed (Nerve Conduction Sum [NCS] score; muscle fiber conduction velocity: fastest/slowest ratio [F/S ratio]).
RESULTS—Both the DNS and the DNE scores discriminated between the DU and DC groups significantly (P < 0.001). The DNE score even discriminated between DC and C (P < 0.05). Spearman’s correlation coefficients between both DNS and DNE scores and cAFT (HRV −0.42 and −0.44; BRS −0.30 and −0.29, respectively) and EDS (NCS 0.51 and 0.62; F/S ratio 0.44 and 0.62, respectively) were high. Odds ratios were calculated for both DNS and DNE scores with cAFT (HRV 4.4 and 5.7; BRS 20.7 and 14.2, respectively) and EDS (NCS 5.6 and 16.8; F/S ratio 7.2 and 18.8, respectively).
CONCLUSIONS—The DNS and DNE scores are able to discriminate between patients with and without PNP and are strongly related to cAFT and EDS. This further confirms the strength of the DNS and DNE scores in diagnosing diabetic PNP in daily clinical practice.
- BRS, baroreflex sensitivity
- cAFT, cardiovascular autonomic function testing
- DNE, Diabetic Neuropathy Examination
- DNS, Diabetic Neuropathy Symptom
- EDS, electro-diagnostic studies
- F/S ratio, fastest/slowest ratio
- HRV, heart rate variability
- MFCV, muscle fiber conduction velocity
- NCS, Nerve Conduction Sum
- PNP, polyneuropathy
- QST, quantitative sensory testing
- RV, reference value
Footnotes
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Address correspondence and reprint requests to Jan-Willem G. Meijer, MD, PhD, Rehabilitation Center Tolbrug, PO Box 90153, 5200 ME Den Bosch, The Netherlands. E-mail: tolbrug{at}boschmedicentrum.nl.
Received for publication 3 June 2002 and accepted in revised form 26 November 2002.
Additional information for this article can be found in an online appendix at http://care.diabetesjournals.org.
A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.
- DIABETES CARE
