Screening for Diabetic Peripheral Neuropathy: Which Tool?

TOPLINE:
Screening tools for diabetic peripheral neuropathy vary in sensitivity, suggesting it may be necessary to use multiple tools to reliably catch the condition.
METHODOLOGY:
Investigators in Malta, the United Kingdom, and Greece conducted a cross-sectional comparative cohort study of peripheral neuropathy screening tools among 63 patients with diabetes.
Each patient underwent testing with four subjective tools (monofilament, neurothesiometer, traditional tuning fork, and electronic tuning fork) and one objective tool (NC-Stat DPNCheck, an automated sural nerve conduction test) in random order.
The main outcome was the percentage of lower limbs classified as having absent sensation below the knee.
TAKEAWAY:
The percentage of lower limbs classified as having absent sensation below the knee differed significantly across the five screening tools (P < .05).
The value was 4.0% with the monofilament, 11.1% with the neurothesiometer, 20.6% with the traditional tuning fork, 23.0%-23.8% with the electronic tuning fork (depending on the mode used), and 32.5% with the automated sural nerve conduction test.
Agreement between pairs of tools was satisfactory (P < .05 in all cases) but weak; the monofilament showed poorest agreement with each of the other tools based on kappa values.
IN PRACTICE:
“Lack of agreement among results obtained from all 5 screening tools indicates the potential occurrence of false positive or false negative outcomes for certain individuals,” the author wrote. “Clinicians can enhance the sensitivity of peripheral neuropathy screening by utilising multiple screening tools. This approach increases the likelihood of identifying cases, even in its early stages, potentially missed by individual screening modalities,” they concluded.
SOURCE:
The study was led by Stephanie Pleven, MSc, University of Malta, Msida, Malta, and was published online in The International Journal of Lower Extremity Wounds. 
LIMITATIONS:
Limitations included the small sample size, use of tools not considered the gold standard, and a lack of follow-up to ascertain prognostic value of the tools’ results.
DISCLOSURES:
The study did not receive any funding. The authors reported no conflicts of interest.
 
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