Background: Distal symmetric polyneuropathy (DSPN) is one of the most prevalent chronic complications of diabetes and the most common cause in the pathway to diabetic foot ulceration. Screening for DSPN enables early intervention and prevention of complications. The Semmes-Weinstein Monofilament Examination (SWME) is currently the method of choice to screen DSPN, but ideally two neurologic tests should be used. The Michigan Neuropathy Screening Instrument (MNSI), which evaluates vibratory sensation and ankle reflex, has been proposed as a useful screening test of DSPN. The objective of this study was to determine the prevalence of DSPN in diabetic patients in general medicine wards.
Methods: Diabetic patients admitted within a 5 months period were evaluated with the MNSI and the SWME after exclusion of other causes of polyneuropathy. A score >2 in the clinical examination of MNSI and ≤7 positive answers in a total of 10 in SWME were considered positive.
Results: Twenty-three patients were included (75.6±13.7 years; 56.5% male; 9.9±6.1 years of disease duration). Only 2 (8.7%) had previously been diagnosed with DSPN. The SWME was positive in only one of these patients while the MNSI was positive in both. In the remaining undiagnosed 21 patients, 12 patients (57.1%) were positive for the MNSI, while 14 (66.7%) were positive for the SWME. Both MNSI and SWME were positive in 10 out of 23 patients (43.5%) and 19 out of 23 (82.6%) had at least one screening test positive.
Conclusion: In this study, more than half of the diabetic patients without a previous diagnosis were screened positive for either the MNSI or SWME test. Data indicates that using both MNSI and SWME increases the detection of DSPN. This study confirms that DSPN is a prevalent complication of diabetes and that hospitalization is an excellent opportunity to screen for DSPN.
20 - 23 May 2017
European Society of Endocrinology