Endocrine Abstracts

Introduction: When diabetes mellitus is diagnosed, peripheral neuropathy is present in about 20 % of cases. Vibratory sense is perceived by mechanoreceptors, which have 2 types, Pacinian corpuscles and Meissner corpuscles. Pacinian corpuscles consist of large myelinated A-beta fibers detecting high frequency vibration and deep pressure. There are new methods to evaluate vibration sense and pressure sensation acting on Aβ, and C type fibres. TENS is considered as a non-invasive, cheap technique. conventional TENS act through stimulating large diameter (A-beta) nerve fibers.

Materials and methods: 100 patients into 2 parallel groups. In all patients (diabetic patients and controls), we evaluated the presence of peripheral neuropathy by using a 128 Hz tuning fork and TENS (Transcutaneous electrical nerve stimulation). Here in this trial we chose 1 point in each foot: the hallux. TENS probes were placed adjacent to the hallux. TENS units intensity ranges from 1 mA to 100 mA. The vibration sense testing using a tuning fork was Performed with a tuning fork with a free vibration frequency of 128 Hz. The measurements were taken at hallux on the right and left foot. According to results we can divide diabetic neuropathy to mild in which the patients fell sense from 40 mA to 60 mA, moderate in which the patients feel sense from above 60 mA to 80 mA, severe in which the patient feel sensation from above 80 mA to 100 mA. control group fell sensation up to 40 mA. a score of vibration perception graded from 0 (no sensation) to 8 loss of sensation after 8 seconds) when using a tuning fork.

Results: The results show a statistically significant difference between diabetic patients and control by using TENS in which there is significant decrease in vibration sense in diabetic patients in comparison to control. With p value less than 0.0001. The results also show a statistically significant difference between diabetic patients and control by using 128 Hz tuning fork, in which there is significant decrease in vibration sense in diabetic patients in comparison to control. With p value less than 0.0001. Comparing sensitivity and specificity of tens on right foot and tuning fork on right foot showing that tens has sensitivity of 94% and specificity 96% and tuning fork sensitivity of 83% and specificity 94 %. Denoting that tens is better than tuning fork in detecting vibration sense and early detection of diabetic peripheral neuropathy.

Conclusion: DPN is very common in diabetic patients but it may take a long time to be diagnosed. This may lead to life threatening complications, like amputation. So it is critical to find new ways of diagnosing DPN early. TENS may be considered as a new way of evaluating DPN.