title: Diabetic neuropathy examination: a hierarchical scoring system to diagnose distal polyneuropathy in diabetes.
abstract: OBJECTIVE
  Existing physical examination scoring systems for distal diabetic polyneuropathy (PNP) do not fulfill all of the following criteria: validity, manageability, predictive value, and hierarchy The aim of this study was to adapt the Neuropathy Disability Score (NDS) to diagnose PNP in diabetes so that it fulfills these criteria.
  
  
  METHODS
  A total of 73 patients with diabetes were examined with the NDS. Monofilaments and biothesiometry were used as clinical standards for PNP to modify the NDS.
  
  
  RESULTS
  A total of 43 men and 30 women were studied; mean duration of diabetes was 15 years (1-43), and mean age was 57 years (19-90). A total of 24 patients had type 1 diabetes, and 49 patients had type 2 diabetes. Clinically relevant items were selected from the original 35 NDS items (specific item scored positive in >3 patients). The resulting 8-item Diabetic Neuropathy Examination (DNE) score could accurately predict the results of the clinical standards and is strongly hierarchical (H value 0.53). The sensitivity and specificity of the DNE at a cut-off level of 3 to 4 were 0.96 and 0.51 for abnormal monofilament scores, respectively. For abnormal vibration perception threshold scores, these values were 0.97 and 0.59, respectively. Reproducibility as assessed by inter- and intrarater agreement was good.
  
  
  CONCLUSIONS
  The DNE is a sensitive and well-validated hierarchical scoring system that is fast and easy to perform in clinical practice.
authors.affiliation: Rehabilitation Centre Beatrixoord, Haren, The Netherlands. j.w.meijer@beatrixoord.nl
authors.forename: J W
authors.initials: JW
authors.lastname: Meijer
authors.forename: E
authors.initials: E
authors.lastname: van Sonderen
authors.forename: E E
authors.initials: EE
authors.lastname: Blaauwwiekel
authors.forename: A J
authors.initials: AJ
authors.lastname: Smit
authors.forename: J W
authors.initials: JW
authors.lastname: Groothoff
authors.forename: W H
authors.initials: WH
authors.lastname: Eisma
authors.forename: T P
authors.initials: TP
authors.lastname: Links
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003922:Diabetes Mellitus, Type 1 / Q000503:physiopathology*; D003924:Diabetes Mellitus, Type 2 / Q000503:physiopathology*; D003929:Diabetic Neuropathies / Q000175:diagnosis* / Q000503:physiopathology; D005260:Female; D005385:Fingers / Q000294:innervation; D006801:Humans; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D011115:Polyneuropathies / Q000175:diagnosis* / Q000503:physiopathology; D012018:Reflex; D015203:Reproducibility of Results; D012684:Sensory Thresholds; D014034:Toes / Q000294:innervation; D014732:Vibration