Clinical Application Value Of Early Screening Methods For Diabetic Peripheral Neuropathy

Background:Diabetic peripheral neuropathy (DPN) is one of the chronic diabetic complications. The definition of DPN is the presence of symptoms and/or signs of peripheral nerve dysfunction in people with diabetes, after exclusion of other causes.The prevalence rate of DPN is high, and the mutilation rate and lethality caused by DPN are also high. So early diagnosis and timely prevention of DPN has important clinical significance.We use the neural electrophysiological test (NET) as the diagnostic gold standard to evaluate the clinical application value of the Neuropathy Total Symptom Score-6(NTSS-6), Leeds Assessment of Neuropathic Symptoms and Signs the self-complete(S-LANSS), Michigan Neuropathy Screening Instrument (MNSI), lOg monofilament and Vibration Perception Threshold (VPT) in early Screening of DPN, in order to find a suitable method, provide the basis for early diagnosis and prevention. We study the impacting factors of DPN.Purpose:1. To evaluate the clinical application of NTSS-6, S-LANSS, MSNI, lOg monofilament and the VPT in DPN screening.2. To explore the impacting factors of DPN. Subjects and Methods:1. To collect108patients with type2diabetes mellitus, who have been hospitalized in the Department of Endocrinology of the second hospital of Shandong University from July,2013to January,2014. They have been diagnosed accord with WHO1999diagnostic criteria for diabetes mellitus.2. Exclusion criteria:peripheral neuropathy caused by other diseases, such as the neck and lumbar disease, cerebrovascular disease, toxic peripheral neuropathy, uremia, joint or tendon lesions, hyperthyroidism or hypothyroidism and so on.3. General clinical parameters were measured and calculated, such as age, sex, T2DM duration, body mass index (BMI), waist to hip ratio(WHR), family history, history of smoking and drinking, diabetic retinopathy, hypertension, blood pressure (including systolic and diastolic blood pressure), fasting blood glucose,2h postprandial blood glucose, fasting C-peptide level,2h postprandial C-peptide level, glycosylated hemoglobin, renal function, blood lipids, urine microalbumin and so on. Each patient was performed the neural electrophysiological test (NET), NTSS-6, S-LANSS, MNSI, lOg monofilament and Vibration Perception Threshold (VPT). Depending on the results of NET, the patients were divided into DPN group and NDPN group.4. We use SPSS19.0to set up the database for statistical analysis. The factors effecting diabetic peripheral neuropathy were undergone with logistic regression analysis. Areas under ROC curve of these methods were analyzed to compare the value of these screening methods.Results:1. The analysis the impacting factors of diabetic peripheral neuropathy:Single factor analysis shows that age, T2DM duration, systolic blood pressure(SBP), serum creatinine(sCr), total cholesterol(TC), low-density lipoprotein cholesterol(LDL-C),2h postprandial C-peptide levels, history of hypertension have significant differences within two groups(P<0.05or0.01).Logistic regression analysis shows that duration, age,2h postprandial C-peptide levels are the impacting factors of DPN. 2. The compare of the diagnostic value of DPN screening methodsUsing the results of the NET as the diagnostic gold standard, the areas under ROC of NTSS-6, S-LANSS (pain degree/scores), MNSI (history/physical assessment) were0.783,0.645/0.673,0.801/0.669. The areas under ROC of lOg monofilament and VPT were0.841,0.888. The optimal cut off point of10g monofilament was1.25, and the sensitivity, specificity, Youden’s index were0.71,0.90,0.61. The optimal cut off point of VPT is16.75; and the sensitivity, specificity, Youden’s index were0.72,0.90,0.62.Using the results of the NET as the diagnostic gold standard, the sensitivity, specificity, Youden’s index of lOg monofilament(<7) were0.448,0.960,0.408; the sensitivity, specificity, Youden’s index of VPT(>25V) were0.293,0.960,0.253.If abnormalities in both examinations were used for diagnosis of DPN, the sensitivity was0.155, and specificity was1.000, Youden’s index was0.155. If abnormalities in either examination were used for diagnosis of DPN, the sensitivity was0.586, and specificity was0.920, Youden’s index was0.506.Conclusions:1. The duration of diabetes, age,2h postprandial C peptide are closely associated with the occurrence of diabetic peripheral neuropathy.2. NTSS-6and MSNI (history) can be used in the outpatient and large-scale cohort. The value of VPT is higher and could be used for early screening of DPN. If abnormalities in either10g monofilament or VPT were used for diagnosis of DPN, the value is more effective.