title: Vibration perception threshold as a measure of distal symmetrical peripheral neuropathy in type 1 diabetes: results from the DCCT/EDIC study.
abstract: OBJECTIVE
  To describe the sensitivity, specificity, positive predictive value, and negative predictive value of vibration perception threshold (VPT) testing in subjects with type 1 diabetes relative to gold standard assessments of peripheral neuropathy.
  
  
  METHODS
  VPT was determined in 1,177 adults with type 1 diabetes 13-14 years after participating in a study of intensive (INT) versus conventional (CONV) diabetes treatment. Abnormal VPT was defined by values exceeding 2.5 SD above age-specific normal values. Signs and symptoms of peripheral neuropathy were assessed and electrodiagnostic studies were performed to establish definite clinical neuropathy, abnormal nerve conduction, and confirmed clinical neuropathy (the presence of both definite clinical neuropathy and abnormal nerve conduction).
  
  
  RESULTS
  Thirty-seven percent of subjects had definite clinical neuropathy, 61% had abnormal nerve conduction, and 30% had confirmed clinical neuropathy. Abnormal VPT was more common among former CONV than among INT subjects (64 vs. 57%, P < 0.05) and was associated with older age. VPT was a sensitive measure of confirmed clinical neuropathy (87%) and of definite clinical neuropathy (80%) and a specific measure of abnormal nerve conduction (62%). Higher VPT cut points improved test sensitivity and lower cut points improved specificity. Areas under the receiver operating characteristic curves ranged from 0.71-0.83 and were higher for older than for younger subjects and highest for those with confirmed clinical neuropathy.
  
  
  CONCLUSIONS
  VPT was a sensitive measure of peripheral neuropathy. Future researchers may choose to select VPT cut points for defining abnormality based on the population studied and clinical outcome of interest.
authors.affiliation: University of Michigan, Ann Arbor, Michigan, USA. martinc@med.umich.edu
authors.forename: Catherine L
authors.initials: CL
authors.lastname: Martin
authors.forename: Barbara H
authors.initials: BH
authors.lastname: Waberski
authors.forename: Rodica
authors.initials: R
authors.lastname: Pop-Busui
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Cleary
authors.forename: Sarah
authors.initials: S
authors.lastname: Catton
authors.forename: James W
authors.initials: JW
authors.lastname: Albers
authors.forename: Eva L
authors.initials: EL
authors.lastname: Feldman
authors.forename: William H
authors.initials: WH
authors.lastname: Herman
mesh_terms: D000293:Adolescent; D000328:Adult; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D010465:Perception / Q000502:physiology*; D010523:Peripheral Nervous System Diseases / Q000209:etiology* / Q000503:physiopathology*; D011237:Predictive Value of Tests; D012684:Sensory Thresholds / Q000502:physiology*; D014732:Vibration; D055815:Young Adult