Diabetes Metab J.  2014 Aug;38(4):285-293. 10.4093/dmj.2014.38.4.285.

Assessment of Diabetic Polyneuropathy and Autonomic Neuropathy Using Current Perception Threshold in Korean Patients with Diabetes Mellitus

• Koo BK
• Ohn JH
• Kwak SH
• Moon MK

• KMID: 2174105
• DOI: http://doi.org/10.4093/dmj.2014.38.4.285

Abstract

BACKGROUND
The current perception threshold (CPT) could be quantified by stimulating Abeta and C fibers at 2,000 and 5 Hz, respectively. C fibers play a role in the autonomic nervous system and are involved in temperature and pain sensation. We evaluated the usefulness of CPT for diagnosing distal polyneuropathy (DPN) and cardiovascular autonomic neuropathy (CAN) in diabetic patients.
METHODS
The CPT was measured in the index finger (C7 level) and in the third toe (L5 level) in diabetic patients aged 30 to 69 years. We assessed DPN according to the neuropathy total symptom score-6 (NTSS-6) and 10-g monofilament pressure sensation. Subjects with a NTSS-6 >6 or with abnormal 10-g monofilament sensation were defined to have DPN. CAN was evaluated by spectral analysis of heart rate variability and by Ewing's traditional tests.
RESULTS
The subjects with DPN had significantly higher CPT at all of the frequencies than the subjects without DPN (P<0.05). Abnormal 10-g monofilament sensation and NTSS-6 >6 could be most precisely predicted by CPT at 2,000 and 5 Hz, respectively. However, only 6.5% and 19.6% of subjects with DPN had an abnormal CPT at 2,000 Hz at the C7 and L5 levels. Although CPT at 5 Hz showed a negative correlation with the power of low and high frequency in the spectral analysis (P<0.05), only 16.7% of subjects with CAN exhibited an abnormal CPT at the same frequency.
CONCLUSION
Although the CPT is significantly associated with neuropathic symptoms or signs corresponding to the nerve fiber stimulated, it provides little additional information compared with conventional evaluations.

Keyword

Cardiac autonomic neuropathy; Current perception threshold; Diabetic neuropathy

MeSH Terms

Autonomic Nervous System
Diabetes Mellitus*
Diabetic Neuropathies*
Fingers
Heart Rate
Humans
Nerve Fibers
Nerve Fibers, Unmyelinated
Polyneuropathies
Sensation
Toes

Figure

• 

  Fig. 1 Receiver operating characteristic (ROC) curve of the current perception threshold (CPT) for predicting neuropathy. (A) ROC curves of CPT for diabetic polyneuropathy, (B) results of the 10-g monofilament test, (C) abnormality of the neuropathy total symptom score-6 (NTSS-6), and (D) autonomic neuropathy. The solid and dashed lines represent the ROC curves of CPT at 2,000 Hz and 5 Hz, respectively, and the black and gray lines represent the ROC curves at the C7 and L5 levels, respectively.

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