title: Clinical neuropathy scales in neuropathy associated with impaired glucose tolerance.
abstract: OBJECTIVE
  Disagreement exists on effective and sensitive outcome measures in neuropathy associated with impaired glucose tolerance (IGT). Nerve conduction studies and skin biopsies are costly, invasive and may have their problems with reproducibility and clinical applicability. A clinical measure of neuropathy that has sufficient sensitivity and correlates to invasive measures would enable significant future research.
  
  
  METHODS
  Data was collected prospectively on patients with IGT and symptomatic early neuropathy (neuropathy symptoms <2years) and normal controls. The seven scales that were examined were the Neuropathy Impairment Score of the Lower Limb (NIS-LL), Michigan Diabetic Neuropathy Score (MNDS), modified Toronto Clinical Neuropathy Scale (mTCNS), Total Neuropathy Score (Clinical) (TNSc), The Utah Early Neuropathy Scale (UENS), the Early Neuropathy Score (ENS), and the Neuropathy Disability Score (NDS).
  
  
  RESULTS
  All seven clinical scales were determined to be excellent in discriminating between patients with neuropathy from controls without neuropathy. The strongest discrimination was seen with the mTCNS. The best sensitivity and specificity for the range of scores obtained, as determined by using receiver operating characteristic curves, was seen for the mTCNS followed by the TNSc. Most scales show a stronger correlation with measures of large rather than small fiber neuropathy.
  
  
  CONCLUSIONS
  All seven scales identify patients with neuropathy. For the purpose of screening potential patients for a clinical study, the mTCNS followed by the TNSc would be most helpful to select patients with neuropathy.
authors.affiliation: Department of Neurology, Maryland VA Healthcare System and University of Maryland, Baltimore, MD, USA.
authors.forename: Lindsay A
authors.initials: LA
authors.lastname: Zilliox
authors.affiliation: Department of Neurology, Maryland VA Healthcare System and University of Maryland, Baltimore, MD, USA.
authors.forename: Sandra K
authors.initials: SK
authors.lastname: Ruby
authors.affiliation: Department of Neurology, Maryland VA Healthcare System and University of Maryland, Baltimore, MD, USA.
authors.forename: Sujal
authors.initials: S
authors.lastname: Singh
authors.affiliation: Department of Neurology, Maryland VA Healthcare System and University of Maryland, Baltimore, MD, USA.
authors.forename: Min
authors.initials: M
authors.lastname: Zhan
authors.affiliation: Department of Neurology, Maryland VA Healthcare System and University of Maryland, Baltimore, MD, USA. Electronic address: JRussell@som.umaryland.edu.
authors.forename: James W
authors.initials: JW
authors.lastname: Russell
mesh_terms: D000368:Aged; D019540:Area Under Curve; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications / Q000503:physiopathology; D003929:Diabetic Neuropathies / Q000150:complications / Q000175:diagnosis; D003943:Diagnostic Techniques, Neurological / Q000592:standards* / Q000706:statistics & numerical data; D005260:Female; D018149:Glucose Intolerance / Q000150:complications* / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010523:Peripheral Nervous System Diseases / Q000150:complications* / Q000175:diagnosis*; D015203:Reproducibility of Results; D012107:Research Design / Q000592:standards / Q000706:statistics & numerical data; D012680:Sensitivity and Specificity
keywords: Clinical scales; Diabetes; Impaired glucose regulation; Neuropathy; Screening tools