Validity and Predictive Value of Screening Tests in Prediabetic and Early Diabetic Polyneuropathy

Authors: Š. Buršováihash2ihash4ihash6ihash8 1,2 1,2 1,2 2,3 1,2
Authors‘ workplace: Neurologická klinika LF MU a FN Brno 1;  CEITEC – Středoevropský technologický institut MU, Brno 2;  Anatomický ústav LF MU, Brno 3;  Institut biostatistiky a analýz MU, Brno 4;  Diabetologické centrum Interní gastro­enterologické kliniky LF MU a FN Brno 5
Published in: Cesk Slov Neurol N 2012; 75/108(5): 562-572
Category: Original Paper


To confirm the validity and predictive value of selected screening tests for neuropathy – The Michigan Neuropathy Screening Instrument (MNSI) and The Utah Early Neuropathy Scale (UENS), and a screening test for detection of neuropathic pain – DN4 – in a population of patients with prediabetes and early type 2 diabetes mellitus (preDM/eDM2).

Patients and methods:
Groups of 17 preDM and 48 eDM2 patients (with duration of disease <3 years), and a control group of 48 healthy subjects without impaired glucose metabolism were extensively evaluated with a focus on large fiber (LFN) and small fiber neuropathy (SFN).

Possible diabetic peripheral neuropathic pain (DPNP) was detected in 15 preDM/eDM2 patients (23.1%). DN4 significantly discriminated patients with and without DPNP, the optimal cut-off value being lower than recommended (≥1 point). MNSI I discriminated patients with and without clinically-based SFN (using cut-off >1 point), while MNSI II discriminated effectively patients with and without both clinically- and laboratory-based LFN (p = 0.003, p <0.001) using recommended cut-offs of ≥2–≥3 points. In addition, UENS discriminated patients with and without clinically-based SFN (p = 0.038) but not those with and without laboratory-based SFN.

DN4 is able to discriminate patients with and without DPNP; the recommended cut-off values, however, provide high specificity but low sensiti­vity (i.e. attributes typical for a confirmatory, not a screening test). MNSI I discriminated patients with clinically-based SFN, although not when the recommended cut-off value of >7 points was used. Both MNSI II and UENS reliably discriminated preDM/eDM2 patients with and without LFN while only UENS discriminated patients with and without clinically-based SFN. Neither test was useful for detection of laboratory-based SFN.

Key words:
prediabetes – type 2 diabetes mellitus – small-fiber neuropathy – large-fiber neuropathy – early diabetic neuropathy


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