Diabetes Metab J.  2018 Dec;42(6):519-528. 10.4093/dmj.2018.0068.

Patterns of Nerve Conduction Abnormalities in Patients with Type 2 Diabetes Mellitus According to the Clinical Phenotype Determined by the Current Perception Threshold

Affiliations
  • 1Department of Neurology, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea.
  • 2Department of Internal Medicine, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea. drwonjc@gmail.com
  • 3Cardiovascular and Metabolic Disease Center, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea.

Abstract

BACKGROUND
Clinical manifestations of diabetic peripheral neuropathy (DPN) vary along the course of nerve damage. Nerve conduction studies (NCS) have been suggested as a way to confirm diagnoses of DPN, but the results have limited utility for evaluating clinical phenotypes. The current perception threshold (CPT) is a complementary method for diagnosing DPN and assessing DPN symptoms. We compared NCS variables according to clinical phenotypes determined by CPT measurements.
METHODS
We retrospectively enrolled patients with type 2 diabetes mellitus who underwent both NCS and CPT tests using a neurometer. CPT grades were used to determine the clinical phenotypes of DPN: normoesthesia (0 to 1.66), hyperesthesia (1.67 to 6.62), and hypoesthesia/anesthesia (6.63 to 12.0). The Michigan Neuropathy Screening Instrument (MNSI) was used to determine a subjective symptom score. DPN was diagnosed based on both patient symptoms (MNSI score ≥3) and abnormal NCS results.
RESULTS
A total of 202 patients (117 men and 85 women) were included in the final analysis. The average age was 62.6 years, and 71 patients (35.1%) were diagnosed with DPN. The CPT variables correlated with MNSI scores and NCS variables in patients with diabetes. Linear regression analyses indicated that hypoesthesia was associated with significantly lower summed velocities and sural amplitudes and velocities, and higher summed latencies, than normoesthesia. Sural amplitude was significantly lower in patients with hyperesthesia than in patients with normoesthesia.
CONCLUSION
NCS variables differed among patients with diabetes according to clinical phenotypes based on CPT and decreased sural nerve velocities was associated with hyperesthesia.

Keyword

Diabetic neuropathies; Neural conduction; Sensory thresholds; Sural nerve

MeSH Terms

Diabetes Mellitus, Type 2*
Diabetic Neuropathies
Diagnosis
Humans
Hyperesthesia
Hypesthesia
Linear Models
Male
Mass Screening
Methods
Michigan
Neural Conduction*
Peripheral Nervous System Diseases
Phenotype*
Retrospective Studies
Sensory Thresholds
Sural Nerve

Figure

  • Fig. 1 Receiver operating characteristic curves of the current perception threshold (CPT) measurements for the diagnosis of diabetic peripheral neuropathy. AUC, area under the curve.


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Association between Sleep Quality and Painless Diabetic Peripheral Neuropathy Assessed by Current Perception Threshold in Type 2 Diabetes Mellitus
Dughyun Choi, Bo-Yeon Kim, Chan-Hee Jung, Chul-Hee Kim, Ji-Oh Mok
Diabetes Metab J. 2021;45(3):358-367.    doi: 10.4093/dmj.2019.0219.


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