Symptom scoring systems to diagnose distal polyneuropathy in diabetes: the Diabetic Neuropathy Symptom score

Aims To provide one of the diagnostic categories for distal diabetic polyneuropathy, several symptom scoring systems are available, which are often extensive and lack in validation. We validated a new four-item Diabetic Neuropathy Symptom (DNS) score for diagnosing distal diabetic polyneuropathy. Methods We compared score characteristics of the generally accepted Neuropathy Symptom Score (NSS) with the DNS score, and tested construct validity, predictive value and reproducibility with the Diabetic Neuropathy Examination score, Semmes-Weinstein monofilaments and Vibration Perception Threshold (clinical standards) in 73 patients with diabetes (24 Type 1, 49 Type 2; 43 male/30 female; mean age 57 years (19-90); mean diabetes duration 15 years (1-43)). Results Correlation between NSS and DNS score was high (Spearman r=0.88). Patient scores were more differentiated on the DNS score. The relation of the NSS and DNS scores, respectively, with clinical standards was good (Spearman r=0.21-0.60). Reproducibility of the DNS score was high (Cohen weighted kappa 0.78-0.95). The DNS score was easier to perform in clinical practice. Conclusions The DNS is validated, fast and easy to perform, with a high predictive value when screening for diabetic polyneuropathy.