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

• Park JH
• Won JC

• KMID: 2449629
• DOI: http://doi.org/10.4093/dmj.2018.0068

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.

Reference

1. American Diabetes Association. Standards of medical care in diabetes: 2016 abridged for primary care providers. Clin Diabetes. 2016; 34:3–21. PMID: 26807004.

2. Won JC, Kwon HS, Kim CH, Lee JH, Park TS, Ko KS, Cha BY. Prevalence and clinical characteristics of diabetic peripheral neuropathy in hospital patients with type 2 diabetes in Korea. Diabet Med. 2012; 29:e290–e296. PMID: 22519862.

3. Russell JW, Zilliox LA. Diabetic neuropathies. Continuum (Minneap Minn). 2014; 20(5 Peripheral Nervous System Disorders):1226–1240. PMID: 25299279.

4. Inceu GV, Veresiu IA. Measurement of current perception thresholds using the Neurometer(R): applicability in diabetic neuropathy. Clujul Med. 2015; 88:449–452. PMID: 26733741.

5. Koo BK, Ohn JH, Kwak SH, Moon MK. Assessment of diabetic polyneuropathy and autonomic neuropathy using current perception threshold in Korean patients with diabetes mellitus. Diabetes Metab J. 2014; 38:285–293. PMID: 25215275.

6. Matsutomo R, Takebayashi K, Aso Y. Assessment of peripheral neuropathy using measurement of the current perception threshold with the neurometer in patients with type 2 diabetes mellitus. J Int Med Res. 2005; 33:442–453. PMID: 16104448.

7. Feldman EL, Stevens MJ, Thomas PK, Brown MB, Canal N, Greene DA. A practical two-step quantitative clinical and electrophysiological assessment for the diagnosis and staging of diabetic neuropathy. Diabetes Care. 1994; 17:1281–1289. PMID: 7821168.

8. Neurotron Inc. Professional feasibility report: Neurometer® electrodiagnostic evaluation in neurology. Baltimore, MD: 2010.

9. Albers JW, Brown MB, Sima AA, Greene DA. Nerve conduction measures in mild diabetic neuropathy in the Early Diabetes Intervention Trial: the effects of age, sex, type of diabetes, disease duration, and anthropometric factors. Tolrestat Study Group for the Early Diabetes Intervention Trial. Neurology. 1996; 46:85–91. PMID: 8559426.

10. England JD, Gronseth GS, Franklin G, Miller RG, Asbury AK, Carter GT, Cohen JA, Fisher MA, Howard JF, Kinsella LJ, Latov N, Lewis RA, Low PA, Sumner AJ. American Academy of Neurology. American Association of Electrodiagnostic Medicine. American Academy of Physical Medicine and Rehabilitation. Distal symmetric polyneuropathy: a definition for clinical research: report of the American Academy of Neurology, the American Association of Electrodiagnostic Medicine, and the American Academy of Physical Medicine and Rehabilitation. Neurology. 2005; 64:199–207. PMID: 15668414.

11. Tesfaye S, Boulton AJ, Dyck PJ, Freeman R, Horowitz M, Kempler P, Lauria G, Malik RA, Spallone V, Vinik A, Bernardi L, Valensi P. Toronto Diabetic Neuropathy Expert Group. Diabetic neuropathies: update on definitions, diagnostic criteria, estimation of severity, and treatments. Diabetes Care. 2010; 33:2285–2293. PMID: 20876709.

12. AAEM Equipment and Computer Committee. American Association of Electrodiagnostic Medicine. Technology review: the neurometer current perception threshold (CPT). Muscle Nerve. 1999; 22:523–531. PMID: 10204790.

13. Herman WH, Kennedy L. Underdiagnosis of peripheral neuropathy in type 2 diabetes. Diabetes Care. 2005; 28:1480–1481. PMID: 15920071.

14. Vas PR, Sharma S, Rayman G. Comment on Breiner et al. Does the prevailing hypothesis that small-fiber dysfunction precedes large-fiber dysfunction apply to type 1 diabetic patients? Diabetes care 2014;37:1418-1424. Diabetes Care. 2014; 37:e240–e241. PMID: 25342838.

15. Jimenez-Cohl P, Grekin C, Leyton C, Vargas C, Villaseca R. Thermal threshold: research study on small fiber dysfunction in distal diabetic polyneuropathy. J Diabetes Sci Technol. 2012; 6:177–183. PMID: 22401337.

16. Rendell MS, Dovgan DJ, Bergman TF, O'Donnell GP, Drobny EP, Katims JJ. Mapping diabetic sensory neuropathy by current perception threshold testing. Diabetes Care. 1989; 12:636–640. PMID: 2791826.

17. Katims JJ, Long DM, Ng LK. Transcutaneous nerve stimulation. Frequency and waveform specificity in humans. Appl Neurophysiol. 1986; 49:86–91. PMID: 3490223.

18. Masson EA, Veves A, Fernando D, Boulton AJ. Current perception thresholds: a new, quick, and reproducible method for the assessment of peripheral neuropathy in diabetes mellitus. Diabetologia. 1989; 32:724–728. PMID: 2591640.

19. Pop-Busui R, Herman WH, Feldman EL, Low PA, Martin CL, Cleary PA, Waberski BH, Lachin JM, Albers JW. DCCT/EDIC Research Group. DCCT and EDIC studies in type 1 diabetes: lessons for diabetic neuropathy regarding metabolic memory and natural history. Curr Diab Rep. 2010; 10:276–282. PMID: 20464532.

20. Takekuma K, Ando F, Niino N, Shimokata H. Prevalence of hyperesthesia detected by current perception threshold test in subjects with glucose metabolic impairments in a community. Intern Med. 2002; 41:1124–1129. PMID: 12521200.

21. The Diabetes Control and Complications Trial Research Group. The effect of intensive diabetes therapy on the development and progression of neuropathy. Ann Intern Med. 1995; 122:561–568. PMID: 7887548.

22. Tesfaye S, Wilhelm S, Lledo A, Schacht A, Tolle T, Bouhassira D, Cruccu G, Skljarevski V, Freynhagen R. Duloxetine and pregabalin: high-dose monotherapy or their combination? The “COMBO-DN study”: a multinational, randomized, double-blind, parallel-group study in patients with diabetic peripheral neuropathic pain. Pain. 2013; 154:2616–2625. PMID: 23732189.

23. Hendriksen PH, Oey PL, Wieneke GH, Bravenboer B, Banga JD. Subclinical diabetic neuropathy: similarities between electrophysiological results of patients with type 1 (insulin-dependent) and type 2 (non-insulin-dependent) diabetes mellitus. Diabetologia. 1992; 35:690–695. PMID: 1644249.

24. Pastore C, Izura V, Geijo-Barrientos E, Dominguez JR. A comparison of electrophysiological tests for the early diagnosis of diabetic neuropathy. Muscle Nerve. 1999; 22:1667–1673. PMID: 10567079.

25. Zhang Y, Li J, Wang T, Wang J. Amplitude of sensory nerve action potential in early stage diabetic peripheral neuropathy: an analysis of 500 cases. Neural Regen Res. 2014; 9:1389–1394. PMID: 25221597.

26. Faul F, Erdfelder E, Buchner A, Lang AG. Statistical power analyses using G*Power 3.1: tests for correlation and regression analyses. Behav Res Methods. 2009; 41:1149–1160. PMID: 19897823.

27. Holman RR, Paul SK, Bethel MA, Matthews DR, Neil HA. 10-Year follow-up of intensive glucose control in type 2 diabetes. N Engl J Med. 2008; 359:1577–1589. PMID: 18784090.

28. Martin CL, Albers J, Herman WH, Cleary P, Waberski B, Greene DA, Stevens MJ, Feldman EL. DCCT/EDIC Research Group. Neuropathy among the diabetes control and complications trial cohort 8 years after trial completion. Diabetes Care. 2006; 29:340–344. PMID: 16443884.