Effectiveness of clinical alternatives to nerve conduction studies for screening for diabetic distal symmetrical polyneuropathy: A multi-center study.
OBJECTIVE
This study explored the possibility of developing an alternative, simple and rapid test for the screening of distal symmetrical polyneuropathy (DSPN), for use in local primary care facilities.


METHODS
4023 patients with type 2 diabetes mellitus (T2DM), aged 18-80 years, from 21 hospitals in China were screened for inclusion in a prospective diagnostic assessment of DSPN, between April 2011 and March 2012. Patients underwent nerve conduction study (NCS; as the gold standard) and clinical assessments of ankle reflexes (AR) and thermal (T), vibration (V), pressure (P), and pinprick (PP) sensations.


RESULTS
Results from various combinations of these clinical assessments were compared to determine the optimal screening regimens. The Toronto Consensus Panel definition was used to confirm clinical DSPN (symptoms or signs plus abnormal NCS). 3883 of the 4023 patients (M:F, 2162:1721; mean age, 56.79±13.16 years) were included. No significant differences were found between the two most efficient clinical assessment combinations, AR+PP+T+V and AR+T+V (P=0.9612). Compared to the diagnosis made using AR+T+V, the same diagnosis was reached using AR+PP+P+V+T in 100% of patients with probable clinical DSPN, 84.05% with possible clinical DSPN, and 96.84% with no DSPN. The AR+T+V assessment was also ∼40% faster than the AR+PP+P+V+T assessment.


CONCLUSIONS
Combined AR+T+V assessment is a valuable tool for screening diabetic patients for DSPN, potentially decreasing costs to local primary care facilities and making care more available to underserved populations.
Department of Endocrinology, Henan Provincial People's Hospital, Zhengzhou 450003, China.
Zhigang
Z
Zhao
Department of Endocrinology and Metabolism, Peking University People's Hospital, Beijing 100044, China. Electronic address: jilnsci@163.com.
Linong
L
Ji
Department of Endocrinology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China.
Lili
L
Zheng
Department of Endocrinology, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, China.
Liyong
L
Yang
Department of Endocrinology, Henan Provincial People's Hospital, Zhengzhou 450003, China.
Huijuan
H
Yuan
Department of Endocrinology, Qilu Hospital of Shandong University, Ji'nan 250012, China.
Li
L
Chen
Department of Endocrinology, The First Hospital of China Medical University, Shenyang 110001, China.
Zhongyan
Z
Shan
Department of Endocrinology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China.
Shanmei
S
Shen
Department of Endocrinology and Metabolism, The 2nd Affiliated Hospital of Harbin Medical University, Harbin 150001, China.
Qiang
Q
Li
Department of Endocrinology, First Affiliated Hospital of Medical College of Xi'an Jiaotong University, Xi'an 710061, China.
Bingyin
B
Shi
Department of Endocrinology, The 306 Hospital of Chinese PLA, Beijing 100101, China.
Yanjun
Y
Liu
Department of Endocrinology, Xijing Hospital, The Fourth Military Medical University, Xi'an 710032, China.
Qiuhe
Q
Ji
Department of Endocrinology and Metabolism, Sixth People's Hospital, Shanghai Jiaotong University, Shanghai 200233, China.
Yuqian
Y
Bao
Department of Endocrinology, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
Xin
X
Gao
Department of Metabolism, Metabolic Diseases Hospital and Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjing 300070, China.
Yun
Y
Xie
Department of Endocrinology, West China Hospital, West China School of Medicine, Sichuan University, Chengdu 610041, China.
Yuping
Y
Liu
Department of Endocrinology, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
Lulu
L
Chen
Department of Endocrinology and Metabolism, Peking University People's Hospital, Beijing 100044, China.
Xueyao
X
Han
Department of Endocrinology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, China.
Fang
F
Wu
Department of Endocrinology, The Second Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510120, China.
Chuan
C
Yang
Department of Endocrinology, General Hospital of PLA, Beijing 100853, China.
Jin
J
Du
Department of Endocrinology, Peking University First Hospital, Beijing 100034, China.
Ying
Y
Gao
Department of Endocrinology, Changhai Hospital, The Second Military Medical University, Shanghai 200433, China.
Dajin
D
Zou
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000175:diagnosis*; D003929:Diabetic Neuropathies / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009431:Neural Conduction / Q000502:physiology*; D009460:Neurologic Examination; D011312:Pressure; D011446:Prospective Studies; D014732:Vibration; D055815:Young Adult
Diabetes; Diabetic neuropathy; Nerve conduction study; Polyneuropathy; Screening