title: Difficulties in screening for peripheral neuropathies in children with diabetes.
abstract: OBJECTIVE
  To assess the diagnostic utility of a novel abbreviated monofilament test in comparison with the tuning fork test to detect diabetic peripheral neuropathy in children.
  
  
  METHODS
  A total of 88 children with Type 1 diabetes mellitus were screened for diabetic peripheral neuropathy using the monofilament test and the tuning fork. Nerve conduction studies were performed according to the 'gold standard' for neuropathy. We assessed the diagnostic utility and inter-rater agreement of the two screening methods.
  
  
  RESULTS
  A total of 43 (49%) children (aged 6-18 years) had at least one abnormal nerve conduction study result. Diagnostic utility and inter-rater agreement were very low for both screening methods. The monofilament test yielded a sensitivity of 18% and a specificity of 80%. The tuning fork yielded a sensitivity of 0% and a specificity of 98%.
  
  
  CONCLUSIONS
  The present study found that an abbreviated monofilament test has low diagnostic utility for the detection of early diabetic peripheral neuropathy because of its low reliability. The problem of reliability needs to be more thoroughly addressed in order to improve the screening procedures in diabetes management in childhood and adolescence.
authors: Faculty of Business Management and Social Sciences, University of Applied Sciences Osnabrück, Osnabrück.|German Paediatric Pain Centre, Children's Hospital Datteln, Datteln.
authors: G
authors: G
authors: Hirschfeld
authors: Witten/Herdecke University, Witten.
authors: M
authors: M
authors: von Glischinski
authors: Pediatric Diabetology and Endocrinology, Children's Hospital Datteln, Datteln.
authors: C
authors: C
authors: Knop
authors: Pediatric Diabetology and Endocrinology, Children's Hospital Datteln, Datteln.
authors: T
authors: T
authors: Wiesel
authors: Witten/Herdecke University, Witten.|Pediatric Diabetology and Endocrinology, Children's Hospital Datteln, Datteln.
authors: T
authors: T
authors: Reinehr
authors: Witten/Herdecke University, Witten.|Pediatric Neurology, Children's Hospital Datteln, Datteln.
authors: F
authors: F
authors: Aksu
authors: Olgahospital Stuttgart, Stuttgart.
authors: M
authors: M
authors: Blankenburg
authors: Institute of Medical Biometrics and Epidemiology, Witten/Herdecke University, Witten, Germany.
authors: J
authors: J
authors: Hirsch
authors: German Paediatric Pain Centre, Children's Hospital Datteln, Datteln.|Witten/Herdecke University, Witten.
authors: B
authors: B
authors: Zernikow
mesh_terms: D000293:Adolescent; D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D003929:Diabetic Neuropathies / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D003940:Diagnostic Techniques, Endocrine / Q000592:standards; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening; D009431:Neural Conduction / Q000502:physiology; D009460:Neurologic Examination / Q000379:methods; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012684:Sensory Thresholds; D014732:Vibration