The patient was asked to report the time when vibration diminished below perception. The 128-Hz tuning-fork test was bilaterally applied to the bony prominence situated at the dorsum of the first toe proximal to the nail bed. A total score ≤8/10 was considered abnormal.
Tuning fork test foot skin#
The total duration of the approach, skin contact, and monofilament removal should be approximately 2 seconds. The monofilament was applied perpendicular to the foot and touched the skin until it bended by approximately 1 cm. Tests for diabetic peripheral polyneuropathy The SWME was performed at 10 touch sites (one dorsal and nine plantar sites) per foot. This study was approved by the Institutional Review Board of the Hanyang University Hospital in Seoul, Korea (No. All included subjects were aged ≥40 years. Subjective neuropathic symptoms were defined as symmetrical burning pain, electrical sensation, stabbing sensation, paresthesia, or deep aching pain in the lower limbs having started at the toes. We excluded 26 patients with chronic alcohol abuse, end stage terminal disease (chronic kidney disease, hepatic dysfunction, or cancer), vitamin deficiency (B1, B6, B12, E, or folic acid), or who were receiving neurotoxic medications. Examinations except for the TSS and MNSI questionnaire were performed by one examiner who did not recognize the presence of symptoms. The subjects were examined with all screening tests including the 10-g Semmes-Weinstein monofilament examination (SWME), the 128-Hz tuning-fork, ankle-reflex, and pinprick tests the Total Symptom Score (TSS), and the 15-item self-administered questionnaire of the Michigan Neuropathy Screening Instrument (MNSI questionnaire) between January 2013 and December 2013 at one tertiary hospital. METHODS Study population We enrolled 162 patients with T2DM who were randomly chosen. In this study, we evaluated the diagnostic correlation of simple and non-invasive methods appropriate for DPNP detection in patients with type 2 diabetes mellitus (T2DM) according to the presence of neuropathic symptoms to reconfirm the necessity of these tests in clinical practice. Various diagnostic methods have so far been developed and used. The identification of potential patients with DPNP, particularly by non-specialists, requires easily applicable and clinically reliable screening and diagnostic methods. However, these procedures are invasive and may be unsuitable for use in clinical practice. To confirm the diagnosis, a nerve-conduction study or skin biopsy is required. Unfortunately, methods for DPNP detection are underutilized in primary-care practice and DPNP is underdiagnosed. Therefore, early recognition and appropriate management of DPNP are important. INTRODUCTION Diabetic peripheral polyneuropathy (DPNP) is the most common microvascular complication and an amputation risk factor in patients with diabetes. Keywords: Diabetes mellitus Diabetic neuropathies Diagnosis Neurologic examination Surveys and questionnaires.Moreover, these tests should be implemented more extensively in diabetic patients without neuropathic symptoms to detect DPNP early.
The largest abnormal response was derived by combining all methods. The abnormal-response rates varied depending on the methods used according to the presence of subjective neuropathic symptoms (18.8% vs. Among 136 patients, 48 had subjective neuropathic symptoms and 88 did not. We enrolled 136 randomly-chosen patients with type 2 diabetes mellitus and examined them with the 10-g Semmes-Weinstein monofilament examination, the 128-Hz tuning-fork, ankle-reflex, and pinprick tests the Total Symptom Score and the 15-item self-administered questionnaire of the Michigan Neuropathy Screening Instrument. We evaluated the necessity of simple, non-invasive tests for DPNP detection in clinical practice.
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