Screening tests for distal symmetrical polyneuropathy in Latin American patients with type 2 diabetes mellitus

Gómez-Banoy, Nicolás; Cuevas, Virginia; Soler, Fernando; Pineda, Maria Fernanda; Mockus, Ismena

doi:10.1590/2359-3997000000283

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Original Articles • Arch. Endocrinol. Metab. 61 (05) • Sept-Oct 2017 • https://doi.org/10.1590/2359-3997000000283 linkcopy

Screening tests for distal symmetrical polyneuropathy in Latin American patients with type 2 diabetes mellitus

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objective This cross sectional study intended to evaluate two bedside tests (Neuropad and VibraTip) as screening tools for distal symmetrical polyneuropathy (DSPN) in Latin American patients with type 2 diabetes mellitus (T2D).

Subjects and methods Ninety-three Colombian patients diagnosed with T2D were recruited. Anthropometric variables, glycemic control parameters, lipid profile and renal function were assessed for each patient. DSPN was defined by a Michigan Neuropathy Screening Instrument (MNSI) clinical score greater than 2. Both Neuropad and Vibratip tests were applied to each patient. Contingency analyses were performed to evaluate the diagnostic power of both tools.

Results The prevalence of DSPN determined clinically by MNSI was 25.8%. DSPN in these patients was associated with age, worsening renal function, and insulin treatment. The sensitivity and specificity of the Neuropad test for DSPN was 66.6% and 63% respectively. Its negative predictive value (NPV) was 84.6%. The VibraTip test exhibited a sensitivity of 54.1% and specificity of 91.3%, with a NPV of 85.1%.

Conclusion Neuropad and VibraTip are reliable screening tools for DSPN in Latin American population. VibraTip presents a considerable diagnostic power for DSPN in this population. Further studies regarding the cost-effectiveness of these tools in clinical practice are needed.

Type 2 diabetes; diabetic neuropathy; complications; diagnostic test

	All patients (n = 93)	Patients with neuropathy (MNSI > 2)	Patients without neuropathy (MNSI ≤ 2)	p
Age (years)	70.8 ± 7.7	75.8 ± 7.3	69.1 ± 7	< 0.001
T2D duration (years)	10.0 ± 8.2	11.5 ± 7.5	9.4 ± 8.4	0.27
Hemoglobin A1C (%)	7.3 ± 1.4	7.5 ± 1.1	7.2 ± 1.5	0.376
Fasting plasma glucose (mg/dL)	130 ± 43	129 ± 35	130 ± 45	0.9241
Triglycerides (mg/dL)	149 ± 55	151 ± 50	148 ± 56	0.829
Total cholesterol (mg/dL)	172 ± 36	170 ± 27	173 ± 38	0.705
HDL cholesterol (mg/dL)	41.9 ± 7.2	40.8 ± 5.8	42.3 ± 7.6	0.392
LDL cholesterol (mg/dL)	100.5 ± 31.9	98.6 ± 21.5	101.1 ± 34.7	0.738
Creatinine (mg/dL)	1.0 ± 0.2	1.1 ± 0.3	0.9 ± 0.2	< 0.001
eGFR (ml/min/1.73 m²)	72 ± 14.5	63.1 ± 14.8	75.1 ± 13	< 0.001
Urinary albumin (mg/L)	54.9 ± 135.6	106.3 ± 225	37 ± 77	< 0.05
BMI (kg/m²)	27.8 ± 3.5	27.5 ± 3.4	27.9 ± 3.6	0.647
Subjects treated with metformin (%)	63,4%	54.2%	66.6%	0.273
Subjects treated with insulin (%)	29%	50%	21.7%	< 0.01
Subjects treated with sulphonylureas (%)	19.4%	16.6%	20.3%%	0.698
Subjects treated with DPP-4 inhibitor (%)	15.1%	12.5%	15.9%	0.684
Subjects treated with ACE inhibitor (%)	18.3%	16.6%	18.8%	0.316
Subjects treated with ARB (%)	46.2%	66.6%	39.1%	< 0.05
Subjects treated with statins (%)	64.5%	66.6%	63.7%	0.798

Reference Test	Sensitivity	Specificity	PPV	NPV
5-item MNSI	66,6%	63.8%	39%	84.6%
128-Hz-tuning fork	39%	82.9%	64%	63.2%
10-g monofilament	24.3%	94.2%	76.9%	61.2%
Ankle reflex	60.9%	71.2%	62.5%	69.8%
VibraTip	29.2%	86.4%	63.1%	60.8%

Reference Test	Sensitivity	Specificity	PPV	NPV
5-item MNSI	54.2%%	91.3%	68.4%	85.1%
128-Hz-tuning fork	73.6%	85.1%	56%	91.7%
10-g monofilament	42.1%	93.2%	61.5%	86.2%
Ankle reflex	89.4%	68.9%	42.5%	96.2%
Neuropad	63.1%	60.8%	29.2%	86.5%

Reference Test	Sensitivity	Specificity	PPV	NVP
128-Hz-Tuning Fork	70.8%	88.4%	68%	89.7%
10-g monofilament	54.2%	100%	100%	86.3%
Ankle reflex	75%	68.1%	45%	88.7%
Neuropad	66.7%	63.8%	39%	84.6%
VibraTip	54.2%	91.3%	68.4%	85.1%

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[TFN1] Data are expressed in Mean ± SD. P values depict differences between patients with and without neuropathy. T2D: type 2 diabetes; HDL: High Density Lipoprotein; LDL: Low Density Lipoprotein; eGFR: estimated Glomerular Filtration Rate; BMI: Body Mass Index; DPP-4: Dipeptidyl Peptidase 4; ACE: Angiotensin Converting Enzyme; ARB: Angiotensin Receptor Blocker.