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Abstract: Distal symmetrical polyneuropathy (DSP) is the most common type of diabetic neuropathy, but often difficult to diagnose reliably. We evaluated the cross-sectional association between three point-of-care devices, Vibratron II, NC-stat®, and Neurometer®, and two clinical protocols, MNSI and monofilament, in identifying those with DSP, and/or amputation/ulcer/neuropathic pain (AUP), the two outcomes of major concern. This report presents data from 195 type 1 diabetic participants of the Epidemiology of Diabetes Complications (EDC) Study attending the 18-year examination (2004–2006). Participants with physician-diagnosed DSP, AUP or who were abnormal on the NC-stat, and the Vibratron II, MNSI, and monofilament were older (p <0.05) and had a longer duration of diabetes (p <0.05). There was no difference by sex for DSP, AUP, or any testing modality, with the exception of NCstat (motor). The Vibratron II and MNSI showed the highest sensitivity for DSP (>87%) and AUP (>80%), whereas the monofilament had the highest specificity (98% DSP, 94% AUP) and positive predictive value (89% DSP, 47% AUP), but lowest sensitivity (20% DSP, 30% AUP). The MNSI also had the highest negative predictive value (83%) and Youden''s Index (37%) and currently presents the single best combination of sensitivity and specificity of DSP in type 1 diabetes. [Copyright &y& Elsevier]

Abstract: Background: Diabetes mellitus is one of the most prevalent chronic diseases worldwide including Singapore. The 10g monofilament is commonly used by clinicians to examine diabetic patients for neuropathy due to its low cost and convenience. The aim of this literature review is to evaluate the use of the monofilament and the factors that affect its diagnostic value. Methods: A systematic search of AMED, Medline, EMBASE and Cinahl databases was conducted to identify English language articles from 1990 to 2009 which investigated the use of the monofilament. Results: A total of 34 studies were identified, consisting of 24 observational studies, 8 prospective studies, 1 review article and 1 randomised controlled trial. 6 recurrent themes emerged from these 34 studies. Conclusions: The 10g monofilament remains a useful clinical tool for detecting severe neuropathy and hence identifying patients at increased risk of ulceration and amputation. However, a consensus on the protocol in the use of the monofilament needs to be reached. Further research regarding the effects of environmental conditions on the accuracy of the monofilament is also essential. [ABSTRACT FROM AUTHOR]

Abstract: We studied the number of testing sites and the proportion needed to be insensate for the optimal assessment of foot ulcer risk with the 10g monofilament. Also, we compared the sensitivity and specificity of the 10g monofilament with other methodologies. Fifty-two individuals with either a current foot ulcer, a history of a foot ulcer or the presence of Charcot neuroarthopathy and 51 individuals with no history of any of these conditions were assessed with the 10g monofilament at four sites on each foot, the 128Hz tuning fork at the halluces, the Biothesiometer at the halluces and the modified neuropathy disability score. Sensitivities and specificities were calculated for the various modalities. The Biothesiometer and the neuropathy disability score had the highest sensitivities (0.92 for both). The 128Hz tuning fork tested only at the halluces (criterion: ≥1 insensate site) had the same sensitivity (0.86) as the 10g monofilament tested at eight sites (criterion: ≥1 insensate site) with similar specificities (0.56 and 0.58, respectively). The Biothesiometer and the modified neuropathy disability score tend to be more sensitive than the 10g monofilament for the assessment of individuals at risk for foot ulcers. The 128Hz tuning fork tested at only two sites is as sensitive as the 10g monofilament tested at eight sites. These data suggest that the 10g monofilament may not be the optimum methodology for identifying individuals at risk of foot ulcers. [Copyright &y& Elsevier]

Abstract: Objective: To determine whether DSP and neuropathy-assessment instruments used by non-physicians have similar risk factors. Research design and methods: Analyses were cross-sectional (n =176). Results: Risk factors were similar for DSP and screening devices. Conclusions: These data support the clinical utility of neuropathy screening devices used by non-physician personnel. [ABSTRACT FROM AUTHOR]