A PRACTICAL 2-STEP QUANTITATIVE CLINICAL AND ELECTROPHYSIOLOGICAL ASSESSMENT FOR THE DIAGNOSIS AND STAGING OF DIABETIC NEUROPATHY

OBJECTIVE - Early diagnosis of distal symmetric sensorimotor polyneuropathy, a common complication of diabetes, may decrease patient morbidity by allowing for potential therapeutic interventions. We have designed an outpatient program to facilitate diagnosis of diabetic neuropathy. RESEARCH DESIGN AND METHODS - Patients are initially administered a brief questionnaire and screening examination, designated the Michigan Neuropathy Screening Instrument (MNSI). Diabetic neuropathy confirmed with a positive examination coupled with nerve conduction studies, designated the Michigan Diabetic Neuropathy Score (MDNS). In this study, 56 outpatients with confirmed type I or II diabetes were administered the standardized quantitative components required to diagnose and stage diabetic neuropathy according to the San Antonio Consensus Statement (1) and the Mayo Clinic protocol (2). These same patients were then assessed with the MNSI and the MDNS. RESULTS- Of 29 patients with a clinical MNSI score > 2, 28 had neuropathy. Twenty-eight patients with an MDNS of greater than or equal to 7 had neuropathy, while 21 nonneuropathic patients had a score less than or equal to 6. Of 35 patients with diabetic neuropathy, 34 had greater than or equal to 2 abnormal nerve conductions. Twenty-one normal patients and one patient with neuropathy had less than or equal to 1 abnormal nerve conduction. CONCLUSIONS - The results indicate that the MNSI is a good screening tool for diabetic neuropathy and that the MDNS coupled with nerve conductions provides a simple means to confirm this diagnosis.