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Senthilkumar S, Dasarathan R, Pazhani P, Gaur A, Sakthivadivel V. Comparing the Ipswich Touch Test (IpTT) and 10gm-SMWF (10-gm Semmes-Weinstein mono-filament) in Indian population subset with type 2 diabetes mellitus to detect diabetes neuropathy. Ir J Med Sci 2023; 192:2793-2799. [PMID: 37140765 DOI: 10.1007/s11845-023-03376-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 04/12/2023] [Indexed: 05/05/2023]
Abstract
BACKGROUND Diabetic neuropathy diagnosis involves invasive procedures like nerve biopsy and nerve conduction studies which are seldom available at rural health centers. The Ipswich Touch Test (IpTT) is one test that can be performed by the caregiver and it's simple to perform. AIM This study was aimed to compare the validity of the IpTT and 10gm-SMWF (10-gm Semmes-Weinstein mono-filament) test with the vibration perception threshold (VPT) using biothesiometer. METHODS Two hundred patients with type 2 diabetes, between the age of 30 and 50 years, were included in the study. The neuropathy assessment was performed by biothesiometer, 10gm-SMWF test, and IpTT. Taking VPT(> 25 V) as the gold standard; the sensitivity and specificity of IpTT and 10gm-SMWF are calculated and compared to each other. RESULTS On comparing with the VPT, the 10gm-SMWF test had a sensitivity of 94.7% and specificity of 85.7%, and the IpTT had a sensitivity of 91.9% and specificity of 85.7%. 10gm-SMWF test (Kappa value 0.733) had better agreement with VPT than IpTT (Kappa value 0.675). On Spearman's correlation, the 10gm-SMWF test and the IpTT had r values of 0.738 and 0.686 respectively (P = 0.000). CONCLUSION 10gm-SMWFis a better test to diagnose neuropathy than the IpTT; but in the absence of 10gm-SMWFs, the IpTT is an ideal alternative. IpTT can be performed in a bedside or chairside setting in the absence of a professional health care provider who can screen patients for neuropathy and alert the physician of an impending complication where amputation can be avoided.
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Affiliation(s)
| | - Ramesh Dasarathan
- Department of General Medicine, Governement Omandurar Medical College, Chennai, India
| | | | - Archana Gaur
- Department of Physiology, All India Institute of Medical Sciences, Bibinagar, Hyderabad, Telangana, India
| | - Varatharajan Sakthivadivel
- Department of General Medicine, All India Institute of Medical Sciences, Bibinagar, Hyderabad, Telangana, 508126, India.
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Ponirakis G, Elhadd T, Chinnaiyan S, Hamza AH, Sheik S, Kalathingal MA, Anodiyil MS, Dabbous Z, Siddique MA, Almuhannadi H, Petropoulos IN, Khan A, Ae Ashawesh K, Dukhan KM, Mahfoud ZR, Zirie MA, Jayyousi A, Murgatroyd C, Slevin M, Malik RA. Prevalence and risk factors for diabetic neuropathy and painful diabetic neuropathy in primary and secondary healthcare in Qatar. J Diabetes Investig 2020; 12:592-600. [PMID: 32799429 PMCID: PMC8015833 DOI: 10.1111/jdi.13388] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 08/06/2020] [Accepted: 08/10/2020] [Indexed: 02/07/2023] Open
Abstract
Aims/Introduction This study determined the prevalence and risk factors for diabetic peripheral neuropathy (DPN) and painful DPN (pDPN) in patients with type 2 diabetes in primary healthcare (PHC) and secondary healthcare (SHC) in Qatar. Materials and Methods This was a cross‐sectional multicenter study. Adults with type 2 diabetes were randomly enrolled from four PHC centers and two diabetes centers in SHC in Qatar. Participants underwent assessment of clinical and metabolic parameters, DPN and pDPN. Results A total of 1,386 individuals with type 2 diabetes (297 from PHC and 1,089 from SHC) were recruited. The prevalence of DPN (14.8% vs 23.9%, P = 0.001) and pDPN (18.1% vs 37.5%, P < 0.0001) was significantly lower in PHC compared with SHC, whereas those with DPN at high risk for diabetic foot ulceration (31.8% vs 40.0%, P = 0.3) was comparable. The prevalence of undiagnosed DPN (79.5% vs 82.3%, P = 0.66) was comparably high, but undiagnosed pDPN (24.1% vs 71.5%, P < 0.0001) was lower in PHC compared with SHC. The odds of DPN and pDPN increased with age and diabetes duration, and DPN increased with poor glycemic control, hyperlipidemia and hypertension, whereas pDPN increased with obesity and reduced physical activity. Conclusions The prevalence of DPN and pDPN in type 2 diabetes is lower in PHC compared with SHC, and is attributed to overall better control of risk factors and referral bias due to patients with poorly managed complications being referred to SHC. However, approximately 80% of patients had not been previously diagnosed with DPN in PHC and SHC. Furthermore, we identified a number of modifiable risk factors for PDN and pDPN.
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Affiliation(s)
- Georgios Ponirakis
- Weill Cornell Medicine-Qatar, Qatar Foundation, Education City, Doha, Qatar.,Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK
| | - Tarik Elhadd
- National Diabetes Center, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.,National Diabetes Center, Al-Wakra Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Subitha Chinnaiyan
- National Diabetes Center, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Abdul H Hamza
- Umm Ghuwailina Primary Health Care, Umm Ghuwailina, Qatar
| | | | | | | | - Zeinab Dabbous
- National Diabetes Center, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Mashhood A Siddique
- National Diabetes Center, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Hamad Almuhannadi
- Weill Cornell Medicine-Qatar, Qatar Foundation, Education City, Doha, Qatar
| | | | - Adnan Khan
- Weill Cornell Medicine-Qatar, Qatar Foundation, Education City, Doha, Qatar
| | - Khaled Ae Ashawesh
- National Diabetes Center, Al-Wakra Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Khaled M Dukhan
- National Diabetes Center, Al-Wakra Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Ziyad R Mahfoud
- Weill Cornell Medicine-Qatar, Qatar Foundation, Education City, Doha, Qatar
| | - Mahmoud A Zirie
- National Diabetes Center, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Amin Jayyousi
- National Diabetes Center, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | | | - Mark Slevin
- Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK
| | - Rayaz A Malik
- Weill Cornell Medicine-Qatar, Qatar Foundation, Education City, Doha, Qatar.,Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK.,National Diabetes Center, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.,Institute of Cardiovascular Science, University of Manchester, Manchester, UK
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Hansen TM, Brock B, Juhl A, Drewes AM, Vorum H, Andersen CU, Jakobsen PE, Karmisholt J, Frøkjær JB, Brock C. Brain spectroscopy reveals that N-acetylaspartate is associated to peripheral sensorimotor neuropathy in type 1 diabetes. J Diabetes Complications 2019; 33:323-328. [PMID: 30733057 DOI: 10.1016/j.jdiacomp.2018.12.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 10/31/2018] [Accepted: 12/28/2018] [Indexed: 01/24/2023]
Abstract
AIMS Emerging evidence shows, that distal symmetric peripheral neuropathy (DSPN) also involves alterations in the central nervous system. Hence, the aims were to investigate brain metabolites in white matter of adults with diabetes and DSPN, and to compare any cerebral disparities with peripheral nerve characteristics. METHODS In type 1 diabetes, brain metabolites of 47 adults with confirmed DSPN were compared with 28 matched healthy controls using proton magnetic resonance spectroscopy (H-MRS) in the parietal region including the sensorimotor fiber tracts. RESULTS Adults with diabetes had 9.3% lower ratio of N-acetylaspartate/creatine (NAA/cre) in comparison to healthy (p < 0.001). Lower NAA/cre was associated with lower sural (p = 0.01) and tibial (p = 0.04) nerve amplitudes, longer diabetes duration (p = 0.03) and higher age (p = 0.03). In addition, NAA/cre was significantly lower in the subgroup with proliferative retinopathy as compared to the subgroup with non-proliferative retinopathy (p = 0.02). CONCLUSIONS The association to peripheral nerve dysfunction, indicates concomitant presence of DSPN and central neuropathies, supporting the increasing recognition of diabetic neuropathy being, at least partly, a disease leading to polyneuropathy. Decreased NAA, is a potential promising biomarker of central neuronal dysfunction or loss, and thus may be useful to measure progression of neuropathy in diabetes or other neurodegenerative diseases.
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Affiliation(s)
- Tine Maria Hansen
- Mech-Sense, Department of Radiology, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Søndre Skovvej 11, 9000 Aalborg, Denmark
| | - Birgitte Brock
- Clinical Biochemistry, Aarhus University Hospital and Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200 Aarhus, Denmark; Steno Diabetes Center Copenhagen, Niels Steensens Vej 6, 2820 Gentofte, Denmark
| | - Anne Juhl
- Department of Clinical Neurophysiology, Aalborg University Hospital, Ladegårdsgade 5, 9000 Aalborg, Denmark
| | - Asbjørn Mohr Drewes
- Department of Clinical Medicine, Aalborg University, Søndre Skovvej 11, 9000 Aalborg, Denmark; Mech-Sense, Department of Gastroenterology & Hepatology, Aalborg University Hospital, Mølleparkvej 4, 9000 Aalborg, Denmark; Steno Diabetes Center North Jutland, Aalborg University Hospital, Mølleparkvej 4, 9000 Aalborg, Denmark
| | - Henrik Vorum
- Department of Clinical Medicine, Aalborg University, Søndre Skovvej 11, 9000 Aalborg, Denmark; Department of Ophthalmology, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark
| | - Carl Uggerhøj Andersen
- Department of Clinical Medicine, Aalborg University, Søndre Skovvej 11, 9000 Aalborg, Denmark; Department of Ophthalmology, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark
| | - Poul Erik Jakobsen
- Steno Diabetes Center North Jutland, Aalborg University Hospital, Mølleparkvej 4, 9000 Aalborg, Denmark; Department of Endocrinology, Aalborg University Hospital, Mølleparkvej 4, 9000 Aalborg, Denmark
| | - Jesper Karmisholt
- Department of Clinical Medicine, Aalborg University, Søndre Skovvej 11, 9000 Aalborg, Denmark; Department of Endocrinology, Aalborg University Hospital, Mølleparkvej 4, 9000 Aalborg, Denmark
| | - Jens Brøndum Frøkjær
- Mech-Sense, Department of Radiology, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Søndre Skovvej 11, 9000 Aalborg, Denmark.
| | - Christina Brock
- Department of Clinical Medicine, Aalborg University, Søndre Skovvej 11, 9000 Aalborg, Denmark; Mech-Sense, Department of Gastroenterology & Hepatology, Aalborg University Hospital, Mølleparkvej 4, 9000 Aalborg, Denmark; Department of Drug Design and Pharmacology, University of Copenhagen, Universitetsparken 2, 2100 Copenhagen, Denmark
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Abstract
Neuropathy is one of the major reasons of morbidity in diabetes mellitus (DM). We presented a 64-year-old male who was a case of type 2 DM for >6 years. He presented with orthopnea and respiratory failure secondary to bilateral phrenic neuropathy and resultant diaphragmatic palsy. Clinical examination, ultrasound, and nerve conduction studies confirmed the bilateral involvement of the phrenic nerves. Phrenic neuropathy may be an important, albeit a rare complication of diabetes, and hence, diaphragmatic dysfunction associated with diabetic phrenic neuropathy should be considered in any patient with unexplained breathlessness, orthopnea, and respiratory failure.
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Affiliation(s)
- Robert Da Costa
- Department of Critical Care, Holy Family Hospital, Mumbai, Maharashtra, India
| | - Pezad Doctor
- Department of Critical Care, Holy Family Hospital, Mumbai, Maharashtra, India
| | - Kaustubh Mahajan
- Department of Critical Care, Holy Family Hospital, Mumbai, Maharashtra, India
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